Ketamine Therapy for PTSD: How It Works and What to Expect

Post-traumatic stress disorder affects roughly one in eleven people at some point in their lives, yet the two most common treatments, antidepressants and exposure-based psychotherapy, fail to produce adequate relief for a substantial portion of patients (Mayo Clinic). For those people, the search for something that actually works can span years. At Soft Reboot Wellness in Menlo Park, we work with patients who have often been through that search already, and we offer two evidence-informed options, IV ketamine therapy and stellate ganglion block (SGB), that work on trauma through entirely different mechanisms than the treatments most patients have tried before.

What PTSD Is Actually Doing to the Brain

Understanding why ketamine may help with PTSD starts with understanding what PTSD is actually doing. Post-traumatic stress disorder develops when the brain’s fear-memory system becomes dysregulated following a traumatic experience. The amygdala (a small, almond-shaped structure deep in the brain that processes fear and threat) becomes hyperactive, firing threat signals in response to stimuli that are objectively safe (National Institutes of Health). This hyperactivity explains the hallmark features of PTSD: intrusive memories, hypervigilance, exaggerated startle responses, emotional numbing, and the persistent feeling of being in danger when the danger has long since passed.

The hippocampus, which under normal circumstances helps contextualize memories and distinguish past from present, is also affected. Chronic stress hormones associated with prolonged trauma impair hippocampal function, making it harder for the brain to file traumatic memories as past events and harder to access the contextual signals that would otherwise calm the amygdala down. The result is a nervous system that is stuck, repeatedly re-experiencing a threat that no longer exists.

Standard antidepressants and many therapy approaches work gradually and indirectly on this system. For patients with deeply entrenched trauma responses, the pace of that approach can be inadequate.

How Ketamine Targets the Trauma Loop

Ketamine works through the glutamate system, specifically through NMDA receptor blockade, which gives it access to the same neural circuits involved in fear memory consolidation and extinction. Research shows that ketamine produces significant and rapid reductions in PTSD symptoms, including intrusive memories and hyperarousal, in ways that standard medications do not (National Institutes of Health). The speed matters: for patients who have been symptomatic for years, experiencing meaningful relief within days of a first infusion is genuinely different from anything they have encountered in a standard treatment timeline.

The proposed mechanism behind this involves ketamine’s ability to promote neuroplasticity, the brain’s capacity to form new connections, in the very circuits that PTSD has locked into a rigid, threat-oriented pattern. When NMDA receptors are transiently blocked, a cascade follows that increases synaptic plasticity, allowing the brain to begin writing new associations over old fear-encoded ones. This is not the same as erasing trauma. It is more accurate to say ketamine may create a window during which the brain is more receptive to change, and that window, when used well, can shift the trajectory of treatment.

At Soft Reboot Wellness, Dr. Sara Herman has trained specifically in Internal Family Systems (IFS) combined with ketamine-assisted psychotherapy, a framework that treats trauma as a system of protective internal parts rather than a single fixed wound. Our ketamine-assisted psychotherapy (KAP) program is designed to use the neuroplastic window that infusions open for meaningful psychological work, not simply to wait it out.

The Role of Stellate Ganglion Block in PTSD Treatment

For patients whose PTSD manifests heavily in the physical symptoms of hyperarousal (elevated heart rate, chronic tension, exaggerated startle, insomnia), we also offer stellate ganglion block (SGB) as a distinct treatment option. SGB involves a precise injection of local anesthetic near the stellate ganglion, a cluster of nerve cell bodies in the neck that is part of the sympathetic nervous system. This system governs the body’s fight-or-flight response.

Research supports SGB as an effective treatment for PTSD symptoms, particularly in patients with treatment-resistant presentations (National Institutes of Health). By temporarily interrupting the overactive sympathetic signals that drive physical hyperarousal, SGB can provide relief from the bodily dimension of PTSD that purely psychological or pharmacological treatments do not always reach. Some patients at Soft Reboot Wellness use SGB and ketamine in combination, scheduled on separate days, and our clinical team can help determine whether that approach makes sense for your specific presentation.

Our SGB protocol is the Dual Sympathetic Reset (DSR), a bilateral, two-level ultrasound-guided approach designed to deliver the most effective results. An initial consultation ($400) is required before any SGB treatment to assess candidacy.

What the Treatment Process Looks Like

For patients considering ketamine therapy for PTSD at Soft Reboot Wellness, the process begins by calling or emailing us. We send you an intake packet, Dr. Herman reviews it, and determines whether to schedule a consultation. We review your full treatment history, what you have tried, for how long, and how you responded, before making any recommendations. If you have an existing therapist or psychiatrist, we actively coordinate with them, because we believe PTSD treatment works better as a team effort than a siloed one.

A standard ketamine induction series involves four to six IV infusions over four to six weeks, with the number and timing personalized to your clinical response. Infusion sessions are personally monitored by Dr. Herman throughout. Vital signs are tracked continuously. The experience during infusion, which may include altered perception of time, a sense of mental quieting, or dreamlike imagery, is temporary, resolves fully before you leave the clinic, and is managed within a safe, supervised environment. You will need a ride home after each session.

Each infusion is paired with preparation and integration support from a certified psychedelic integration coach as part of our ketamine-assisted psychotherapy (KAP) program. The 48 to 72 hours following a session are a particularly rich window for reflection and integration work, and our coaching component is structured around that timeline.

Addressing the Fear of Retraumatization

One concern patients with PTSD sometimes raise is whether the altered state produced by ketamine might itself be destabilizing or retraumatizing. This is a fair question, and one we address directly during the consultation process. For most patients, the dissociative quality of a ketamine infusion, the sense of the mind loosening from ordinary thought patterns, is experienced as a relief rather than a threat. But candidacy for ketamine therapy is assessed individually, and patients with certain trauma histories or psychiatric comorbidities may not be appropriate candidates. We make that determination during the medical and psychiatric review before any treatment begins.

On scheduling: ketamine infusion sessions do not require time off work beyond the treatment day itself. Most patients return to their routines the following day. We offer appointment availability designed to accommodate demanding professional schedules, a practical consideration for the Silicon Valley professionals who make up a significant portion of our patient community.

On cost: IV ketamine therapy is an off-label treatment for PTSD, and insurance coverage is not standard. SGB coverage also varies. We encourage you to contact our team at 650-419-3330 or hello@softrebootwellness.com before your consultation to get a clear picture of the financial commitment involved. Results vary by individual, and we encourage all patients to discuss their options with their existing healthcare providers before beginning.

Frequently Asked Questions

How quickly might I notice a difference after a ketamine infusion for PTSD? Research documents that ketamine can produce rapid, robust reductions in PTSD symptom severity, sometimes within hours to days of a first infusion (National Institutes of Health). That said, the degree and speed of response varies significantly between individuals. Some patients notice meaningful changes after the first or second infusion; others require the full induction series before effects consolidate. We track mood and symptom data through the Osmind platform throughout your treatment so your response can be assessed objectively.

Can I continue my existing PTSD medications and therapy while doing ketamine treatment? In most cases, yes, and we actively encourage continuity with your existing care team. The specific medications you are taking will be reviewed during your consultation to ensure there are no contraindications. Many patients continue their existing therapy alongside ketamine treatment and find the two approaches complement each other.

What is the difference between ketamine therapy and SGB for PTSD? Ketamine works through the glutamate-neuroplasticity pathway and is primarily associated with improvements in the cognitive and emotional dimensions of PTSD, intrusive memories, mood, and emotional reactivity. SGB works through the sympathetic nervous system and tends to be most effective for the physical hyperarousal symptoms, elevated heart rate, chronic tension, startle response, and sleep disturbance. Some patients benefit from both, and we can discuss which may be most relevant to your presentation during a consultation.

Is ketamine therapy appropriate for all types of trauma? Candidacy depends on your individual history, current medications, psychiatric profile, and the nature of your trauma. We conduct a thorough medical and psychiatric review before recommending any treatment. Not everyone is an appropriate candidate, and we will tell you honestly if we think another path is better suited to your situation.

Key Takeaways

• PTSD involves measurable dysregulation of the brain’s fear-memory system, particularly the amygdala and hippocampus, changes that standard antidepressants address only partially.
• Ketamine works through NMDA receptor blockade to promote neuroplasticity in fear-circuit pathways, producing rapid PTSD symptom reductions in clinical research.
• Stellate ganglion block (SGB) targets the sympathetic nervous system and may specifically address the physical hyperarousal symptoms of PTSD.
• Soft Reboot Wellness in Menlo Park offers both IV ketamine therapy and SGB, with a KAP program that uses Dr. Herman’s IFS training to support integration.
• Results vary by individual; all treatment begins with a thorough consultation and candidacy review.

PTSD does not have to mean a permanent state of threat. If you have been searching for something that works differently than what you have tried, we would like to have a real conversation about your options. Call us at 650-419-3330 or email hello@softrebootwellness.com to get started.

References

1. Mayo Clinic. Symptoms and causes of post-traumatic stress disorder. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
2. National Institutes of Health. Research on the amygdala’s role in fear and stress responses provides a neurological basis for understanding how ketamine may interrupt PTSD’s fear-memory cycle. https://pmc.ncbi.nlm.nih.gov/articles/PMC2882379/
3. National Institutes of Health. Clinical research demonstrates that ketamine produces significant and rapid reductions in PTSD symptoms, including intrusive memories and hyperarousal. https://pmc.ncbi.nlm.nih.gov/articles/PMC10979792/
4. National Institutes of Health. Research published in a peer-reviewed journal supports stellate ganglion block as an effective treatment for PTSD symptoms, particularly in patients with treatment-resistant presentations. https://pmc.ncbi.nlm.nih.gov/articles/PMC6865253/

Medical Disclaimer: The information in this blog is for educational purposes only and does not constitute medical advice. Treatment for PTSD, including IV ketamine therapy and stellate ganglion block, should only be pursued under the supervision of a licensed medical provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.