PTSD Treatment Options: What to Explore When Standard Care Hasn’t Been Enough

PTSD treatment options generally start with psychotherapy, medication, or a combination of the two. For many people, that care makes a real difference. For others, progress is slower or less complete than they hoped, and they begin to wonder what else might be worth exploring.

This guide covers the main PTSD treatment options, why some people look further, and what research currently says about ketamine. It is meant to educate, not to diagnose or promise results.

What Are the Main PTSD Treatment Options?

Two armchairs angled toward each other beside a small table in a bright, calm room, representing a conversation about PTSD treatment options
Many PTSD treatment options begin with a conversation.

Two main types of care are generally used:

  • Psychotherapy. Often called talk therapy, it can happen one on one or in a group. Many types are used, including trauma focused approaches that help people work through difficult memories at a manageable pace.
  • Medication. Antidepressants are commonly prescribed and may help with some symptoms. Other medications are sometimes used for specific concerns, such as sleep problems.

Some people use one approach. Others use both. The best fit depends on the person, which is why working closely with a therapist and prescriber matters.

Why Some People Look for More PTSD Treatment Options

People respond to treatment differently, and improvement often comes gradually. An experienced mental health professional can help find a plan that fits a person’s symptoms and needs. When symptoms have not eased the way someone hoped, it is worth raising that with their care team.

That can be hard to live with. Many people who have stayed committed to therapy and medication feel tired, frustrated, or unsure what comes next. Asking about more PTSD treatment options is not a sign of giving up. It is a way of continuing to look for the right fit.

It also does not mean walking away from current care. Anyone considering a new option should keep their current care team part of the conversation.

What Does Research Say About Ketamine for PTSD?

Ketamine acts differently than traditional antidepressants. Researchers have studied it for several conditions, including treatment resistant depression and PTSD.

Research reviews describe encouraging early findings for PTSD, and many of the side effects discussed are short lasting. They also note that the long term effects of ketamine are still unclear.

In plain terms, the research is encouraging but still developing. Ketamine is not a first line treatment for PTSD, and it is not a replacement for therapy or medication. For some people, it is an option worth discussing with a provider.

How Scenic City Neurotherapy Approaches PTSD Treatment in Chattanooga

Comfortable waiting area with chairs, plants, and an aquarium at Scenic City Neurotherapy in Chattanooga, TN
Our waiting area in Chattanooga, where every consultation begins with a conversation.

Scenic City Neurotherapy is a brain health clinic in Chattanooga, Tennessee, focused on restoring brain function through individualized, research driven care. Our ketamine infusion therapy is delivered through MSKIT® (Minimally Stimulated Ketamine Infusion Therapy), our proprietary protocol. Treatments are administered by Certified Registered Nurse Anesthesiologists (CRNAs) in a comfortable, private setting. We have been serving patients since 2019, and we are an active research site.

You can learn more about how we support people exploring care for PTSD on our PTSD treatment page, or read about the Scenic City difference.

For veterans, we are a contracted VA Community Care Network provider. Veterans with a VA referral are eligible for coverage through their VA benefits for both ketamine therapy and TMS. The first step is asking a VA provider for a Community Care referral. From there, our team confirms the referral, schedules the consultation, and helps with the paperwork. You can read the details on our SCN Service Program page.

Every plan starts with a conversation. During a consultation, a provider reviews a person’s history, asks what has been tried so far, and helps explain which options may be worth exploring.

Our PTSD page describes ketamine as something that may work best together with trauma focused therapy. Infusion sessions themselves are quiet and restful, and no one is asked to talk about their trauma during treatment. We also offer TMS therapy as a different path for some people.

Questions to Ask When Comparing PTSD Treatment Options

A little preparation can make any consultation more useful. Some questions worth bringing:

  • Which therapies and medications have been tried, and for how long?
  • How might ketamine infusion therapy fit with current care?
  • What does the research support, and where is it still uncertain?
  • What does the treatment process look like from the first visit forward?
  • If a veteran, how do VA Community Care referrals work?

Frequently Asked Questions About PTSD Treatment Options

What are the most common PTSD treatment options? Psychotherapy, medication, or a combination of both are the main approaches.

Is ketamine a first line treatment for PTSD? No. Therapy and medication are the main established approaches. Research on ketamine for PTSD is still developing, and long term effects are not yet clear.

Does Scenic City Neurotherapy work with veterans? Yes. We are a contracted VA Community Care Network provider. Veterans with a VA referral are eligible for coverage through their VA benefits for ketamine therapy and TMS, and our team helps with the referral process. You can call (423) 228-0579 to talk it through.

How do I know if it is time to explore other PTSD treatment options? There is no single answer. A good starting point is a conversation with the current care team. Some people also schedule a consultation to learn what other options exist and whether any might fit.

Where can I find PTSD treatment options in Chattanooga? Scenic City Neurotherapy serves Chattanooga and nearby communities, including Cleveland, Hixson, Ooltewah, Knoxville, Dalton, Ringgold, and Birmingham.

Related Reading From Our Providers

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Ready to explore your options? Learn more about our approach to PTSD or request a consultation. A provider will reach out within one business day. There is no cost and no obligation.

If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).

OCD Treatment Options: What to Know When First Line Care Hasn’t Been Enough

OCD treatment options usually begin with two well studied approaches: a type of talk therapy called exposure and response prevention (ERP), and medications that act on serotonin. These are known as first line treatments, and they help many people. But they do not work the same way for everyone, and some people keep looking for other paths forward.

 

October is a good time to talk about it. International OCD Awareness Week is observed each October, and many people use the month to learn more.

 

This guide walks through the main OCD treatment options, why some people look beyond them, and what research currently says about ketamine. It is written to educate, not to diagnose or promise results.

What Are the First Line OCD Treatment Options?

Research reviews describe two main first line OCD treatment options, often used together:

 

  • Exposure and response prevention (ERP). A structured type of therapy where a trained therapist helps a person gradually face situations that trigger distress while practicing not responding with compulsions.
  • Serotonin reuptake inhibitors (SRIs). Medications that act on serotonin, a chemical messenger in the brain involved in mood and anxiety.

 

These approaches remain the foundation of OCD care. Anyone thinking about other OCD treatment options should keep their current therapist and prescriber part of the conversation.

Why Some People Look Beyond First Line Care

Not everyone responds to first line treatment the same way. Some people notice only partial relief. Others find that progress takes longer than they hoped, or that side effects make a medication hard to continue.

 

When first line care has not provided the results someone hoped for, providers sometimes use the term treatment resistant OCD. It is not a label about the person. It simply describes how a particular approach has gone so far.

 

Living with that can be exhausting. Many people feel stuck, frustrated, and unsure what to try next. Wanting to learn about more OCD treatment options is a reasonable next step, not a sign of giving up.

What Does Research Say About Ketamine for OCD?

Ketamine works differently than SRIs. Instead of acting mainly on serotonin, it affects glutamate, another chemical messenger in the brain. That difference is one reason researchers have studied ketamine for OCD.

A systematic review published in the Harvard Review of Psychiatry looked at the available studies. It noted the potential for fast onset and good tolerability. It also noted that results have been inconsistent, that most studies used a single intravenous session, and that larger, better designed trials are still needed.

That is an honest picture. Ketamine for OCD is an area of active research. It is not a settled answer, and it is not a first line treatment.

How Scenic City Neurotherapy Approaches OCD Treatment Options

Scenic City Neurotherapy is a brain health clinic in Chattanooga, Tennessee, focused on restoring brain function through individualized, research driven care. Our ketamine infusion therapy is delivered through MSKIT® (Minimally Stimulated Ketamine Infusion Therapy), our proprietary protocol. Treatments are administered by Certified Registered Nurse Anesthesiologists (CRNAs) in a comfortable, private setting. We have been serving patients since 2019, and we are an active research site.

 

You can read more about how we support people exploring care for OCD on our OCD treatment page, or learn about our overall approach.

 

Every plan starts with a conversation. During a consultation, a provider reviews a person’s history, asks what has been tried so far, and helps explain which options may be worth exploring.

 

At Scenic City Neurotherapy, ketamine is considered an adjunct to ongoing care, not a replacement for it. Our providers coordinate timing with a patient’s therapist, and no one should change a medication without talking with their prescriber first. You can read more about how we work with other providers.

 

Ketamine is also not the only option we offer. Transcranial magnetic stimulation (TMS) is a non invasive, drug free treatment with FDA clearance for OCD. A consultation helps weigh how ketamine, TMS, or both might fit a person’s history and goals. Learn more about TMS therapy.

Questions to Bring to a Consultation

A little preparation can make the conversation more useful. Some questions worth bringing:

 

  • Which first line treatments have been tried, and for how long?
  • How might ketamine infusion therapy fit with current therapy and medications?
  • What does the research support, and where is it still uncertain?
  • What does the treatment process look like from the first visit forward?
  • What would an individualized plan look like?

Frequently Asked Questions About OCD Treatment Options

What are the most common OCD treatment options? The two most established OCD treatment options are exposure and response prevention therapy and serotonin reuptake inhibitor medications. They are often used together and are considered first line care.

 

What does treatment resistant OCD mean? It is a term providers sometimes use when first line care has not provided the relief someone hoped for. It describes the treatment experience, not the person.

 

Is ketamine a first line treatment for OCD? No. Ketamine for OCD is still being studied. Early research points to potential, but results have been inconsistent and larger trials are needed.

 

Does ketamine replace OCD therapy or medication? No. At Scenic City Neurotherapy, ketamine is considered an adjunct to ongoing care, not a replacement for it. Our providers coordinate with a patient’s therapist, and medication changes should always be made with a prescriber.

 

Is TMS one of the OCD treatment options? Yes. TMS is a non invasive, drug free treatment with FDA clearance for OCD, and Scenic City Neurotherapy offers it. A consultation can help weigh whether TMS, ketamine, or both may fit.

 

How do I know if it is time to explore other OCD treatment options? There is no single answer. A good starting point is a conversation with the current care team. Some people also schedule a consultation to learn what other options exist and whether any might fit.

 

Where can I learn about OCD treatment options in Chattanooga? Scenic City Neurotherapy serves Chattanooga and nearby communities, including Cleveland, Hixson, Ooltewah, Knoxville, Dalton, Ringgold, and Birmingham. Our FAQ page covers common questions, and our team is happy to answer others.

 

Wondering what your next step could look like? Request a consultation. A provider will reach out within one business day to answer your questions. There is no cost and no obligation.

5 Ketamine Therapy Myths, Debunked With Research

Ketamine therapy myths are everywhere, and they can keep people from exploring a treatment option that might actually help. Ketamine therapy has grown a lot in recent years, and with that growth has come a lot of misinformation. Some of it comes from outdated ideas about ketamine as a party drug. Some comes from confusion with newer treatments like Spravato®. Here’s a clear look at five of the most common ketamine therapy myths, and what’s actually true.

Myth 1: “Ketamine Therapy Is Just Recreational Drug Use in a Clinical Setting”

The reality: The dose, delivery method, and monitoring involved in clinical ketamine therapy are entirely different from recreational use. In a clinical setting, ketamine is administered intravenously in carefully calculated, individualized doses, well below levels associated with recreational use, by trained clinical staff who monitor vital signs throughout the session. The goal isn’t a “high.” It’s a controlled, brief window during which the brain may become more receptive to positive change.

Myth 2: “Ketamine Just Masks Symptoms Like a Typical Medication”

The reality: Traditional antidepressants generally work by adjusting neurotransmitter levels day to day, which is why they often need to be taken continuously to maintain effect. Ketamine’s research is focused on something different: its potential role in supporting neuroplasticity, the brain’s ability to form new neural connections. That’s part of why clinics like ours describe this as brain health care, not just symptom management. It’s about exploring change at a deeper level, not covering up how you feel in the moment.

Myth 3: “Ketamine Therapy Is Unsafe or Unregulated”

The reality: Ketamine has been used safely in medical settings, including surgical anesthesia, for decades. In a reputable clinic, treatment is administered by qualified clinical staff. At Scenic City Neurotherapy, that means Certified Registered Nurse Anesthesiologists (CRNAs) with extensive anesthesia experience, in a monitored environment with safety protocols in place before, during, and after each session. That’s a very different picture from unsupervised or at-home use, which carries real risks and isn’t something we recommend or support.

Myth 4: “If Antidepressants Didn’t Work for Me, Nothing Will”

The reality: This is one of the most common, and most discouraging, myths we hear. Traditional antidepressants don’t work the same way for everyone, and a lack of response to one type of treatment doesn’t mean every option has been exhausted. Ketamine therapy is often explored specifically by people who feel like they’ve tried everything else, because its mechanism works differently than standard antidepressants. Exploring another option isn’t giving up. It’s often the next reasonable step.

Myth 5: “Ketamine Therapy Is a Last Resort With No Real Science Behind It”

The reality: Ketamine’s use for treatment-resistant depression and related conditions has been the subject of a growing body of clinical research over the past two decades, including peer-reviewed research published by the National Institutes of Health examining its use in treatment-resistant patients. Scenic City Neurotherapy is also an active research site, contributing data on patient response as part of the broader effort to better understand how individualized ketamine protocols like MSKIT® may support brain health. This is an evolving, evidence-informed field, not a fringe treatment.

 

Note: Any specific data points about research outcomes or treatment volumes should be confirmed with the clinical team before publishing, since these figures are updated periodically as the research program continues.

More Ketamine Therapy Myths, Answered (FAQ)

The questions below cover a few more common ketamine therapy myths and misunderstandings.

 

Is ketamine therapy safe? When administered in a clinical setting by trained providers with proper monitoring, ketamine therapy has an established safety profile. Every patient’s history is reviewed individually before treatment begins.

 

Does ketamine therapy work like a typical antidepressant? No. Traditional antidepressants and ketamine are believed to work through different mechanisms. Ketamine’s research is centered on neuroplasticity, while most antidepressants focus on adjusting neurotransmitter levels over time.

 

Is ketamine therapy only for people who’ve tried everything else? Many people explore ketamine therapy after other approaches haven’t provided the results they hoped for, but it’s worth discussing during a consultation regardless of where you are in your treatment history.

 

What makes MSKIT® different from standard ketamine infusion therapy? MSKIT® (Minimally Stimulated Ketamine Infusion Therapy) is Scenic City Neurotherapy’s proprietary, individualized protocol, developed with a focus on personalized dosing and a research-driven approach to brain health rather than a one-size-fits-all infusion.

 

Have more questions about how ketamine therapy works? Schedule a consultation with our team. We’re happy to walk through what the research says and answer your specific questions.

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Long COVID Brain Fog: Understanding the Science and Exploring Care Options

Long COVID brain fog is a pattern of memory, focus, and mental fatigue problems that can linger for months after a COVID-19 infection. It’s one of the most commonly reported lingering effects of the virus, and researchers are still working to fully understand why it happens and what helps.

 

If lingering mental fog has made ordinary tasks feel harder than they used to, you’re not imagining it, and you’re not alone.

What Is Long COVID Brain Fog?

“Brain fog” isn’t an official diagnosis. It’s a term people use to describe a cluster of symptoms that can include:

 

  • Trouble concentrating or staying on task
  • Slower processing speed
  • Word-finding difficulty
  • Short-term memory lapses
  • Mental fatigue that doesn’t improve with rest
  • A general sense of mental “cloudiness”

 

For some people, these symptoms fade within weeks. For others, they persist for months as part of what’s now widely referred to as long COVID.

Why It Happens

Researchers are still studying the exact mechanisms behind long COVID brain fog, but a few contributing factors show up repeatedly in the research:

 

  • Neuroinflammation. Some studies suggest COVID-19 can trigger ongoing inflammation that affects brain function.
  • Disrupted energy metabolism in brain cells. Fatigue and slowed thinking may be linked to how efficiently brain cells are using energy after infection.
  • Changes in blood flow and vascular function. Reduced blood flow to certain brain regions has been observed in some long COVID patients.
  • Sleep disruption and dysautonomia. Poor sleep and nervous system dysregulation, both common after COVID-19, can independently worsen concentration and memory.

 

None of these explanations is the whole picture on its own, most researchers believe long COVID brain fog results from a combination of factors, which is part of why it can be difficult to treat with a single, one-size-fits-all approach.

Why a Single-Symptom Approach May Fall Short

Because long COVID brain fog often overlaps with fatigue, mood changes, and sleep issues, addressing the mental fog alone, without looking at overall brain health, may not lead to lasting improvement. Many people who have researched their options say they’re looking for care that treats the brain as a connected system rather than managing one symptom at a time.

Exploring Brain Health Support at Scenic City Neurotherapy

Scenic City Neurotherapy approaches long COVID brain fog as a brain health question, not just a symptom to mask. Our team looks at the whole picture, including neuroplasticity, brain function, and individualized care, rather than offering a generic protocol.

 

Depending on your history and goals, options explored during a consultation may include:

 

  • MSKIT® (Minimally Stimulated Ketamine Infusion Therapy): an individualized, research-informed protocol administered by experienced CRNAs in a comfortable clinical setting
  • TMS (Transcranial Magnetic Stimulation): a non-invasive option some patients explore alongside other brain health strategies
  • A personalized care plan built around your specific symptoms, history, and goals, not a one-size-fits-all template

 

Every plan starts with a conversation. We don’t assume what’s driving your symptoms, we listen, ask questions, and help you understand what options may be worth exploring.

 

Note: Scenic City Neurotherapy is an active research site studying treatment response; program details and current data should be confirmed with the clinical team before being cited publicly, as figures are updated periodically.

Frequently Asked Questions

Is long COVID brain fog permanent? For many people, symptoms improve over time, though timelines vary widely from person to person. Ongoing brain fog is worth discussing with a care team rather than waiting it out indefinitely.

 

Is brain fog a real medical symptom or just stress? Brain fog is a widely reported and increasingly studied symptom following COVID-19 infection. It’s a real, recognized experience, not “just stress,” even though it isn’t a formal diagnosis on its own.

 

What kind of provider should I talk to about long COVID brain fog? Because long COVID brain fog can involve several overlapping systems, a brain health-focused clinical team that looks at the full picture, rather than treating a single symptom in isolation, may offer a more complete evaluation of your options.

 

Where can I learn more about brain health options in Chattanooga? You can learn more about the approach Scenic City Neurotherapy takes to brain health and neuroplasticity, or reach out directly to schedule a consultation and ask questions specific to your situation.

 

Ready to talk through your options? Schedule a consultation with our team to discuss what a personalized brain health plan could look like for you.

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Spravato® vs Ketamine Infusion Therapy

Spravato® vs Ketamine Infusion Therapy

By Charles Miller, CRNA, CMO, Founder/Owner of Scenic City Neurotherapy

 

If you’ve been researching ketamine therapy for enough time, chances are you’re curious about the comparison between Spravato® vs ketamine infusion therapy. One of the most common misconceptions in mental health treatment is that Spravato® and ketamine infusion therapy are interchangeable.

They are not.

Both treatments are derived from ketamine. Both can help patients with treatment-resistant depression. Both have an important role in psychiatric care. But they are not the same treatment, and patients should not expect identical outcomes.

Why Spravato® vs Ketamine Infusion Therapy Matters

When someone tells me they “tried ketamine and it didn’t work,” one of my first questions is: “Did you receive intravenous ketamine infusion therapy or intranasal esketamine (Spravato®)?” Many patients are surprised to learn that these are different treatments.

Spravato® is an intranasal medication that contains esketamine, one component of the ketamine molecule. Ketamine infusion therapy delivers ketamine directly into the bloodstream through a carefully controlled intravenous infusion. The route of administration matters. In medicine, how a medication reaches the body can dramatically influence its effectiveness.

Looking at the Numbers

The TRANSFORM-2 trial, one of the landmark studies supporting Spravato®, reported:

  • Response rate: 69%
  • Remission rate: 36%

Those are meaningful outcomes. Many patients improve with Spravato®, and for some patients it can be life-changing.

But those numbers also tell another story.

If 1,000 patients receive Spravato®, approximately:

  • 690 will experience significant improvement.
  • 310 will not.

In our recent retrospective analysis of 252 patients treated with a standardized neuroplasticity-focused ketamine infusion protocol, we observed:

  • Response rate: 82%
  • Remission rate: 55%

Applied to the same 1,000-patient example:

  • 820 would experience significant improvement.
  • 180 would not.

That difference represents approximately 130 additional patients achieving meaningful relief. For those individuals, the choice of treatment may determine whether they improve or continue to struggle.

The Wrong Conclusion

One of the most concerning misconceptions is the belief that failure to respond to Spravato® means a patient has “failed ketamine.” That conclusion is not supported by the available evidence. A patient who does not respond to intranasal esketamine has not necessarily failed intravenous ketamine therapy. They have failed one ketamine-derived treatment delivered through one route of administration. Those are not the same thing.

Insurance Coverage & Clinical Outcomes are Not the Same

Many patients choose Spravato® because it is covered by insurance while ketamine infusion therapy often requires out-of-pocket payment. That decision is understandable.

Unfortunately, insurance coverage is determined by regulatory approval and reimbursement policy – not by which treatment produces the highest response and remission rates. Patients deserve to know that distinction.

The treatment most likely to be covered is not always the treatment most likely to help.

The Bottom Line

Spravato® can work. For many patients, it works well. But the evidence suggests that ketamine infusion therapy produces meaningfully higher response and remission rates than intranasal esketamine. Patients should not assume these therapies are equivalent, and they should not assume that a lack of response to Spravato® means ketamine therapy has failed.

The question should not be: “Did I try ketamine?”

The better question is: “Did I receive the form of ketamine treatment most likely to help me achieve recovery?”


References

Popova, V., Daly, E. J., Trivedi, M., Cooper, K., Lane, R., Lim, P., Mazzucco, C., Hough, D., Thase, M. E., Shelton, R. C., Molero, P., Vieta, E., Bajbouj, M., Manji, H., Drevets, W. C., & Singh, J. B. (2019). Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study. The American journal of psychiatry, 176(6), 428–438. https://doi.org/10.1176/appi.ajp.2019.19020172

Jones, B. D. M., Razza, L. B., Weissman, C. R., Karbi, J., Vine, T., Mulsant, L. S., Brunoni, A. R., Husain, M. I., Mulsant, B. H., Blumberger, D. M., & Daskalakis, Z. J. (2021). Magnitude of the Placebo Response Across Treatment Modalities Used for Treatment-Resistant Depression in Adults: A Systematic Review and Meta-analysis. JAMA network open, 4(9), e2125531. https://doi.org/10.1001/jamanetworkopen.2021.25531

Miller, C., Lopes, B., McCurdy, A., & Diller, T. (2026). Analysis of standardized neuroplasticity-focused ketamine therapy in treatment-resistant depression: A longitudinal retrospective study [Manuscript under review].


About Scenic City Neurotherapy

At Scenic City Neurotherapy, we help people find real answers and lasting relief through advanced, evidence-based treatments designed to address the root of mental health and chronic pain challenges, not just the symptoms.

Founded in 2019 by Charles Miller, CRNA, our clinic leads the way in Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (TMS) – two cutting-edge therapies proven to safely and effectively restore healthy brain communication.

Our approach is evidence-backed, informed by research, and focused on helping you feel clear, resilient, and capable of moving forward.


If you’re ready for treatment that’s built on proof, not trial and error, contact us today.

📞 (423) 228-0579

🌐 www.ScenicCityNeuro.com

5 Questions to Ask Before Ketamine Infusion Therapy

5 Questions to Ask Before Ketamine Infusion Therapy

By Charles Miller, CRNA, CMO, Founder/Owner of Scenic City Neurotherapy

Choosing a ketamine provider involves more than comparing prices or reading online reviews. The questions you ask before beginning treatment can have a meaningful impact on your experience, safety, and confidence in your care. Understanding how ketamine is administered, who will be monitoring you, and why a provider follows a particular protocol can help you make a more informed decision. Before scheduling treatment, consider these five important questions to ask before ketamine infusion therapy at any ketamine clinic.


Quick Answer: 5 Questions to Ask Before Ketamine Infusion Therapy
  • How will ketamine be administered?
  • What medications will be added?
  • Who will monitor treatment?
  • Is psychotherapy performed during treatment?
  • What dosing protocol is used?

How Will Ketamine Be Administered?

The route of administration is one of the most important factors affecting both the safety and effectiveness of ketamine therapy. Common routes include oral (troches or tablets), intranasal, intramuscular (IM) injection, and intravenous (IV) infusion.

Understanding the Different Routes of Administration

Each route has advantages and disadvantages. Oral and intranasal ketamine have lower and more variable absorption than IV administration. As a result, blood concentrations can be less predictable, making it more difficult to achieve a consistent therapeutic effect. These routes are also commonly prescribed for frequent at-home use, which may increase the risk of tolerance, dependence, urinary complications, and other adverse effects when used repeatedly over long periods.

Intramuscular (IM) injection provides more reliable absorption than oral or intranasal administration and can be an effective treatment option. However, once the medication is administered, the dose cannot be adjusted or discontinued. If a patient becomes uncomfortable or experiences an unexpected medical issue, the medication must simply run its course.

Intravenous (IV) administration is widely considered the gold standard because it provides 100% bioavailability, precise dosing, and continuous control throughout the treatment. The infusion can be adjusted, slowed, or stopped at any time based on the patient’s response. IV administration also allows immediate access for medications or interventions should a medical concern arise.

Why Scenic City Neurotherapy Uses IV Infusions

For the reasons listed above, IV ketamine offers the highest degree of precision, safety, and patient comfort. Although many patients are initially apprehensive about receiving an IV, the discomfort is typically brief, and ketamine itself possesses analgesic properties that often minimize physical discomfort during treatment.

At Scenic City Neurotherapy, we administer ketamine exclusively by IV infusion. Although other routes of administration are available and often more convenient or profitable, convenience and profitability are not the factors that guide our treatment decisions. We have chosen to focus solely on IV ketamine because it offers the most precise dosing, the most predictable delivery, and the highest level of clinical control. When patients place their trust in us, we believe they deserve the treatment method most likely to produce the best outcome—not simply the easiest method to provide.

What Other Medications Will Be Added?

One of the most important questions to ask is whether additional medications will be administered alongside ketamine.

Some treatment providers routinely add medications such as benzodiazepines (Valium, Xanax, Ativan, Versed) or opioids in an effort to reduce anxiety, blunt the treatment experience, or make patients more comfortable during the infusion. While these medications certainly have appropriate uses in medicine, they may not always be compatible with the goals of ketamine therapy.

Why Additional Medications Matter

A growing body of evidence suggests that benzodiazepines can diminish ketamine’s antidepressant effects and may reduce the likelihood of achieving an optimal response. Opioids present additional concerns, including sedation, respiratory depression, and the potential to alter the therapeutic experience. For these reasons, medications that may interfere with ketamine’s mechanisms of action should be used only when there is a clear medical indication.

At Scenic City Neurotherapy, our goal is not to suppress or medicate away the ketamine experience. Instead, we focus on preparing patients through education, setting expectations, creating a calm and supportive environment, and carefully titrating the infusion to the individual’s needs. When patients understand what to expect and are properly supported throughout the process, most find treatment to be comfortable and many describe it as a pleasant experience.

Questions Every Patient Should Ask

Ketamine is not simply a medication. It is a catalyst for neuroplastic change. Every additional medication should be carefully evaluated based on whether it supports or interferes with that process. Before beginning treatment, ask your provider which medications are routinely administered, why they are used, and whether they may affect treatment outcomes.

Who Will Be Monitoring Me?

Ketamine is an exceptionally safe medication when administered appropriately, but it is still an anesthetic. Anesthetic drugs are used every day in operating rooms and procedural settings, and healthcare professionals spend years developing the knowledge and skills necessary to administer them safely.

The Importance of Qualified Medical Oversight

While ketamine has one of the strongest safety profiles among anesthetic medications, it should still be treated with the respect any anesthetic deserves. Saying ketamine is the safest anesthetic is a bit like saying it is the safest firearm. Safety depends not only on the tool itself, but also on the training, judgment, and experience of the person using it.

Your provider should be physically present and immediately available throughout your treatment. They should be well versed in airway management, cardiovascular monitoring, emergency medications, and the recognition and treatment of potential complications. Although serious adverse events during ketamine therapy are rare, the ability to respond effectively if they occur is an important component of patient safety.

Questions About Provider Training

Unfortunately, the administration of anesthetic medications by clinicians with limited anesthesia training has become increasingly common in a variety of practice settings. Patients should not hesitate to ask who will be monitoring them, what training that individual has received, and whether they are qualified to manage an airway or treat a medical emergency should one arise.

When considering ketamine therapy, remember that the medication is only one part of the treatment. The training, competency, and availability of the person administering and monitoring that medication are equally important.

Do You Utilize Ketamine-Assisted Psychotherapy (KAP)?

Ketamine-Assisted Psychotherapy (KAP) has become increasingly popular, but patients should carefully examine the assumptions behind the practice before accepting it as a necessary component of treatment.

Understanding the Role of Psychotherapy During Ketamine

Psychotherapy has traditionally been performed when patients are fully capable of critical thinking, informed decision-making, memory formation, and accurate self-reflection. Ketamine, as an anesthetic, temporarily alters attention, perception, memory formation, judgment, and suggestibility. Patients should ask an important question: if these capacities are considered important during conventional psychotherapy, why would they be considered less important during psychotherapy performed under the influence of an anesthetic?

Proponents of KAP often argue that the altered state produced by ketamine enhances therapeutic work. While this idea is appealing, the scientific evidence supporting that conclusion remains limited. More importantly, ketamine’s antidepressant and neuroplastic effects appear to be driven primarily by biological mechanisms rather than by the content of conversations occurring during the infusion itself.

Research suggests that ketamine initiates a cascade of cellular and molecular events that promote neuroplasticity. However, the formation, stabilization, and integration of new neural connections occur largely after the acute effects of the medication have subsided. This raises an important question: if ketamine creates the biological conditions necessary for change, why would psychotherapy be expected to work best while the brain is experiencing the cognitive effects of an anesthetic rather than afterward, when the patient is fully capable of participating in the therapeutic process?

Evaluating the Evidence Behind KAP

Patients should ask their provider why they believe psychotherapy during the ketamine experience improves outcomes. Ask what evidence supports that position. Ask how they address concerns regarding memory reliability, suggestibility, and informed consent during an altered state of consciousness. Most importantly, ask whether they can demonstrate that therapy performed during ketamine produces better outcomes than therapy performed after ketamine.

Psychotherapy can be an invaluable part of recovery. The question is not whether therapy is beneficial. The question is whether the optimal time for therapy is during an anesthetic state, or during the period of enhanced neuroplasticity that follows. A thoughtful provider should be able to clearly explain their reasoning and the evidence supporting their approach.

What Dose, Duration, & Delivery Method Do You Use?

The answer to this question can tell you a great deal about a provider’s understanding of ketamine therapy.

Ask what dose they administer, how long the infusion lasts, and how the medication is delivered. A quality provider should be able to answer these questions clearly and explain the reasoning behind their protocol.

Why Protocol Matters

For the treatment of depression and related mental health conditions, ketamine is commonly administered at doses ranging from approximately 0.5 to 1.2 mg/kg over a period of about 40 minutes. While individual patients may require adjustments, providers should be able to explain why they selected a particular dose and how that dose is modified over the course of treatment.

Patients should also ask whether the medication is delivered using a programmable infusion pump or simply allowed to run from an IV bag. An infusion pump allows precise control over the rate of administration and ensures that the intended dose is delivered consistently throughout the treatment. Precision matters when administering an anesthetic.

Duration is equally important. Infusions delivered too rapidly may produce an unnecessarily intense experience, while excessively prolonged infusions may alter the therapeutic effect and make dosing less predictable. A 40-minute infusion has been the most extensively studied and remains the foundation upon which much of the ketamine literature is built.

Questions That Help You Compare Providers

Most importantly, ask your provider how they arrived at their protocol. Is it based on scientific literature, extensive clinical experience, or simply convenience? A thoughtful provider should be able to explain not only what they do, but why they do it.

Ketamine therapy is far more than simply administering a medication. Success depends on delivering the right dose, over the right duration, with the right equipment, for the right patient.


About Scenic City Neurotherapy

At Scenic City Neurotherapy, we help people find real answers and lasting relief through advanced, evidence-based treatments designed to address the root of mental health and chronic pain challenges, not just the symptoms.

Founded in 2019 by Charles Miller, CRNA, our clinic leads the way in Minimally Stimulated Ketamine Infusion Therapy (MSKIT®) and Transcranial Magnetic Stimulation (TMS) – two cutting-edge therapies proven to safely and effectively restore healthy brain communication.

Our approach is evidence-backed, informed by research, and focused on helping you feel clear, resilient, and capable of moving forward.


If you’re ready for treatment that’s built on proof, not trial and error, contact us today.

📞 (423) 228-0579

🌐 www.ScenicCityNeuro.com