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.
Research reviews describe two main first line OCD treatment options, often used together:
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.
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.
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.
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.
A little preparation can make the conversation more useful. Some questions worth bringing:
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.
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.
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.
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.
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.
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.
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.
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 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.
“Brain fog” isn’t an official diagnosis. It’s a term people use to describe a cluster of symptoms that can include:
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.
Researchers are still studying the exact mechanisms behind long COVID brain fog, but a few contributing factors show up repeatedly in the research:
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.
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.
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:
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.
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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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.
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.
The TRANSFORM-2 trial, one of the landmark studies supporting Spravato®, reported:
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:
In our recent retrospective analysis of 252 patients treated with a standardized neuroplasticity-focused ketamine infusion protocol, we observed:
Applied to the same 1,000-patient example:
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.
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.
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.
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?”
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].
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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
By Charles Miller, CRNA, CMO, Founder/Owner of Scenic City Neurotherapy
Recently, I had a conversation with a psychiatrist regarding a shared patient receiving ketamine infusion therapy. The patient had undergone stabilization and achieved an excellent clinical response. For months afterward, her self-reported depression scores on the PHQ-9 remained below even the threshold for mild depression. By many conventional measures, the depressive illness had substantially improved.
And yet one symptom cluster persisted: anxiety.
This is where modern mental health care often reaches a crossroads. When a patient improves in one domain but continues to suffer in another, clinicians should be willing to ask a difficult but necessary question:
In this case, the patient was taking Cymbalta (duloxetine), a commonly prescribed SNRI antidepressant. Like many medications in its class, its prescribing information acknowledges the potential for adverse effects such as anxiety, nervousness, restlessness, agitation, and even panic symptoms in some individuals.
That does not mean the medication is “bad.” It means the medication is biologically active, and biologically active treatments can help, harm, or do both depending on the patient, timing, dose, and context.
My suggestion was straightforward: if depression remained in remission, perhaps a cautious, gradual, hyperbolic taper could be considered to evaluate whether the patient’s anxious state might lessen over time. The response was not curiosity. It was defensiveness.
Unfortunately, that response is not uncommon.
Yet in clinical psychiatry – as in many specialties – there can be a tendency to interpret persistent symptoms through only one lens:
Sometimes those interpretations are correct.
But sometimes the medication itself contributes to the very symptoms being treated.
This is not controversial pharmacology. It is basic clinical reasoning.
Many patients are started on antidepressants during a genuine period of suffering. Some benefit meaningfully. Some partially benefit. Some experience side effects but remain on them for years because no one revisits the original rationale.
Once a medication becomes part of the baseline, clinicians may stop questioning whether it is still helping.
That is not patient-centered care. That is therapeutic inertia.
Prescribers carry enormous responsibility. They make decisions under uncertainty. They want to protect patients. No one wants to feel that a treatment they recommended might be contributing to distress. But professionalism requires the ability to tolerate that possibility.
The goal is not to defend prior decisions. The goal is to help the person in front of us now. We need a culture that values re-evaluation as much as initiation.
These questions should not be seen as threats to expertise. They are signs of expertise.
For many psychiatric medications, discontinuation should not be abrupt or casual. Careful tapering, often slower than traditionally taught, may be necessary, especially after long-term use.
Hyperbolic tapering models deserve more attention because receptor occupancy and neuroadaptation are rarely linear. Small reductions at lower doses can produce disproportionately large physiologic effects.
To psychiatrists, primary care clinicians, nurse practitioners, physician assistants, and all prescribers:
Please remain open to the possibility that a persistent symptom may not always signal under treatment. Sometimes it signals the need to reassess treatment itself.
Please welcome thoughtful interdisciplinary feedback rather than dismissing it.
Please make room for de-prescribing conversations with the same seriousness given to prescribing conversations.
Please remember that changing course in light of new evidence is not weakness, but rather the essence of good medicine.
Patients do not need clinicians who are loyal to medications. They need clinicians who are loyal to outcomes.
And sometimes the most important prescription is the courage to reconsider the last one.
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
