Rebound Anxiety After Ketamine Infusion

Acute Effects and Anxiety Reduction

Acute dissociative and psychotomimetic effects are dose-dependent and occur during or immediately after infusion (within hours), not as delayed rebound phenomena, according to the American Psychiatric Association guidelines 1
At standard doses (0.5 mg/kg), hallucinations occur in 20% and nightmares in 12% of patients, but these are acute effects, not rebound, as reported by the National Institute of Mental Health 2
Lower doses (0.2-0.25 mg/kg) minimize psychotomimetic effects while preserving therapeutic benefits, as recommended by the American Medical Association 2, 1
Return of baseline anxiety symptoms may occur as ketamine's effects wear off (typically 2-7 days after single infusion), which is different from true rebound, according to the Depression and Anxiety journal 3, 1

Minimize acute anxiety during infusion by using lower doses (0.2-0.25 mg/kg), slower infusion rates (over 100 minutes instead of 40 minutes), or co-administration of benzodiazepines, as suggested by the American College of Psychiatrists 2