Post-traumatic stress disorder affects millions of U.S. adults, and some patients continue to experience disabling symptoms after completing evidence-based care such as prolonged exposure therapy, EMDR, or medication treatment (National Institute of Mental Health [NIMH], n.d.; U.S. Department of Veterans Affairs & U.S. Department of Defense [VA/DoD], 2023). At The Invictus Clinic in Marietta, Georgia, we offer IV ketamine infusion therapy for PTSD as an off-label option. For patients across the Atlanta metro area who have tried first-line options without sufficient relief, we want to explain how this glutamate-based approach works and what the evidence currently shows.
Why PTSD Is So Difficult to Treat
PTSD is not simply a psychological response to trauma. It is a condition associated with changes in brain systems involved in threat detection, memory, emotional regulation, and cognitive flexibility, including the amygdala, hippocampus, and prefrontal cortex (Bremner, 2006). Traumatic memories can remain linked to intense emotional and physiological responses, contributing to intrusive memories, hypervigilance, avoidance, and a persistent sense of threat.
Trauma-focused psychotherapies are recommended as first-line care for PTSD when available and appropriate. Sertraline, paroxetine, and venlafaxine are also guideline-supported medication options for some patients (VA/DoD, 2023). These treatments help many people, but not everyone experiences adequate relief. For a closer look at how trauma is stored and addressed physically, see our post on how to release trauma from the body.
The Glutamatergic Mechanism in PTSD
Ketamine’s potential role in PTSD stems from its action on the glutamatergic system. Glutamate is the brain’s primary excitatory neurotransmitter, and NMDA receptors, or N-methyl-D-aspartate receptors, are an important part of glutamate signaling.
Research suggests that glutamate-related changes may be involved in PTSD, including processes related to synaptic plasticity in brain regions that help regulate fear and memory (Averill et al., 2017; Krystal et al., 2017). Ketamine temporarily blocks NMDA receptors and is associated with downstream changes involving AMPA signaling, BDNF, and synaptic plasticity. The precise mechanisms behind ketamine’s effects on PTSD remain under study.
Think of BDNF as part of the scaffolding the brain uses to support neural connections. In PTSD, researchers are examining whether ketamine-related changes in synaptic function may help some patients process traumatic memories with less reflexive alarm. This is not about erasing memories. It is about the possibility of improving the brain’s capacity to contextualize those memories without becoming overwhelmed by them. To understand more about how ketamine interacts with the brain at a neurological level, read our overview of how ketamine affects the brain.
What the Research Shows
The clinical evidence for ketamine and PTSD is still developing, and results vary by individual. A 2014 randomized controlled trial found that a single IV ketamine infusion was associated with a greater reduction in PTSD symptom severity than an active control 24 hours after treatment (Feder et al., 2014).
A later randomized controlled trial of repeated IV ketamine infusions found greater improvement in PTSD symptom severity after two weeks compared with an active control in adults with chronic PTSD (Feder et al., 2021). These findings are encouraging, but they do not establish ketamine as a first-line PTSD treatment.
The current VA/DoD guideline suggests against ketamine for the primary treatment of PTSD because the overall evidence has not demonstrated a clear benefit across studies and populations (VA/DoD, 2023). This is why we approach treatment decisions carefully, review each patient’s full history, and encourage continued coordination with a patient’s broader mental health team. You can also review what the research says about ketamine for treatment-resistant PTSD.
IV Ketamine for PTSD Is Used Off-Label
We are transparent about this: IV ketamine for PTSD is used off-label. Off-label use means an approved medication is being used for a condition that is not included in its FDA-approved labeling (U.S. Food and Drug Administration [FDA], 2018).
SPRAVATO®, or esketamine, is FDA-approved for treatment-resistant depression in adults and for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior when used with an oral antidepressant. It is not approved for PTSD (FDA, 2025). To better understand how SPRAVATO® compares to IV ketamine, our post on SPRAVATO® vs ketamine therapy outlines the key differences.
Some patients with PTSD may also have treatment-resistant depression. When that is the case, we can discuss whether SPRAVATO® may be appropriate based on the patient’s diagnosis, history, and eligibility. Anthem BCBS, Aetna, and Medicare coverage may be available for qualifying patients, and our team verifies benefits before treatment begins.
What the Infusion Experience Looks Like
We understand that patients with PTSD may have particular concerns about entering an altered state of consciousness, especially those with trauma histories involving helplessness or loss of control. We take this seriously.
Before any infusion, our team conducts a thorough evaluation of your medical and psychiatric history, prior treatment experience, medications, and relevant safety considerations. Infusions are administered in a private, calm setting with continuous monitoring.
At subanesthetic doses, ketamine can produce temporary dissociative or perceptual effects. Individual experiences vary. We will discuss what the treatment experience may feel like, answer your questions, and help you make an informed decision before moving forward. For a detailed walkthrough of what to expect, see our post on ketamine therapy in Marietta, GA: inside a session.
Addressing Cost: IV Ketamine for PTSD in Marietta
IV ketamine is not typically covered by insurance for PTSD. At The Invictus Clinic, infusions are priced between $400 and $1,000 per session. We offer a 15% discount when an initial infusion series is paid upfront, along with a 25% discount for active military personnel, veterans, and first responders. CareCredit financing is also available.
SPRAVATO® may be covered by Anthem BCBS, Aetna, or Medicare for qualifying patients with treatment-resistant depression. We encourage every patient to discuss both clinical and financial considerations openly with our team so we can help clarify available options.
A Note on Integration
Many patients receiving ketamine are also working with therapists, psychiatrists, or other mental health providers. Research into the best ways to combine ketamine with psychotherapy is still developing, and treatment should not replace established PTSD care.
We encourage patients to continue working with licensed mental health providers alongside treatment at our clinic. A broader treatment plan can help ensure that your ketamine protocol is considered in the context of your full history, needs, and goals.
Frequently Asked Questions
Is ketamine therapy effective for PTSD?
Research remains mixed. Small randomized controlled trials have found rapid PTSD symptom reductions for some participants after IV ketamine, but current VA/DoD guidance suggests against ketamine as a primary PTSD treatment because the overall evidence has not yet demonstrated clear benefit across studies and populations (Feder et al., 2014; Feder et al., 2021; VA/DoD, 2023). Results vary by individual, and a comprehensive evaluation is required before treatment.
How many infusions are needed for PTSD?
Published studies have used different treatment schedules, including six infusions over two weeks in one clinical trial (Feder et al., 2021). The number, timing, and duration of infusions we recommend will depend on your history, response, safety considerations, and treatment goals.
Is the ketamine experience safe for someone with a trauma history?
We take this question seriously. Ketamine may not be appropriate for everyone with PTSD. Before treatment, we review your history, medications, and concerns about dissociation or loss of control. During treatment, patients are monitored continuously. Please discuss your full history with your provider so we can determine whether this approach is appropriate for you.
Will my insurance cover ketamine for PTSD?
IV ketamine for PTSD is not typically covered by insurance. SPRAVATO® may be covered by Anthem BCBS, Aetna, or Medicare for qualifying patients with treatment-resistant depression. Our team can help you understand coverage verification and financial options during consultation.
Does ketamine erase traumatic memories?
No. Ketamine is not intended to erase memories. Research into PTSD focuses on symptom reduction and potential changes in neural pathways related to fear, memory, and emotional regulation. Discuss realistic treatment goals with your provider based on your individual situation.
Key Takeaways
- PTSD is associated with changes in brain systems involved in memory, threat detection, and emotional regulation.
- Ketamine acts on the glutamatergic system through NMDA receptor antagonism and is associated with downstream neuroplasticity-related pathways.
- Small randomized controlled trials have found rapid PTSD symptom reduction for some patients receiving IV ketamine, but the broader evidence remains mixed.
- IV ketamine for PTSD is used off-label. The VA/DoD guideline currently suggests against ketamine as a primary PTSD treatment because the evidence has not demonstrated clear benefit across studies and populations.
- SPRAVATO® is FDA-approved for specific depressive-disorder indications, not PTSD.
- A comprehensive evaluation and ongoing coordination with your mental health providers are important before beginning treatment.
You do not have to keep living at the mercy of your nervous system. At The Invictus Clinic, we bring together clinical expertise and compassionate care for patients across the Atlanta metro area who are ready to explore a different approach. Call us at 770-580-1042 or schedule a consultation at our Marietta, GA office.
References
Averill, L. A., Purohit, P., Averill, C. L., Boesl, M. A., Krystal, J. H., & Abdallah, C. G. (2017). Glutamate dysregulation and glutamatergic therapeutics for PTSD: Evidence from human studies. Neuroscience Letters, 649, 147-155. DOI: 10.1016/j.neulet.2016.11.064 https://pubmed.ncbi.nlm.nih.gov/27916636/
Bremner, J. D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445-461. DOI: 10.31887/DCNS.2006.8.4/jbremner https://pubmed.ncbi.nlm.nih.gov/17290802/
Feder, A., Costi, S., Rutter, S. B., Collins, A. B., Govindarajulu, U., Jha, M. K., Horn, S. R., Kautz, M., Corniquel, M., Collins, K. A., Bevilacqua, L., Glasgow, A. M., Brallier, J., Pietrzak, R. H., Murrough, J. W., & Charney, D. S. (2021). A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. American Journal of Psychiatry, 178(2), 193-202. DOI: 10.1176/appi.ajp.2020.20050596 https://pubmed.ncbi.nlm.nih.gov/33397139/
Feder, A., Parides, M. K., Murrough, J. W., Perez, A. M., Morgan, J. E., Saxena, S., Kirkwood, K., Aan Het Rot, M., Lapidus, K. A. B., Wan, L.-B., Iosifescu, D., & Charney, D. S. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 71(6), 681-688. DOI: 10.1001/jamapsychiatry.2014.62 https://pubmed.ncbi.nlm.nih.gov/24740528/
Krystal, J. H., Abdallah, C. G., Averill, L. A., Kelmendi, B., Harpaz-Rotem, I., Sanacora, G., Southwick, S. M., & Duman, R. S. (2017). Synaptic loss and the pathophysiology of PTSD: Implications for ketamine as a prototype novel therapeutic. Current Psychiatry Reports, 19, 74. DOI: 10.1007/s11920-017-0829-z https://pmc.ncbi.nlm.nih.gov/articles/PMC5904792/
National Institute of Mental Health. (n.d.). Post-traumatic stress disorder. National Institutes of Health. https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd
U.S. Department of Veterans Affairs & U.S. Department of Defense. (2023). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. https://www.healthquality.va.gov/guidelines/MH/ptsd/
U.S. Food and Drug Administration. (2018). Understanding unapproved use of approved drugs “off label”. https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
U.S. Food and Drug Administration. (2025). SPRAVATO® (esketamine) nasal spray: Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s016lbl.pdf
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Treatment for PTSD, depression, anxiety, and trauma-related conditions, including IV ketamine infusion therapy and SPRAVATO®, should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. SPRAVATO® is FDA-approved for specific indications; IV ketamine for psychiatric conditions is used off-label. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide & Crisis Lifeline or go to your nearest emergency room.
