Roughly one in three people with major depressive disorder experience treatment-resistant depression, commonly defined as an inadequate response to at least two adequate antidepressant trials (McIntyre et al., 2023). For people who have spent years cycling through antidepressants without meaningful relief, learning that a different biological approach exists can be an important part of the conversation.

At Soft Reboot Wellness in Menlo Park, California, we offer physician-supervised IV ketamine therapy for treatment-resistant depression. Dr. Sara Herman, MD, a Harvard-trained anesthesiologist, has guided more than 10,000 patients through anesthesia, pain management, and ketamine therapy. We want patients across the Bay Area to understand what this treatment actually involves.

A Different Biological Approach to Depression

Treatment-resistant depression is not a diagnosis of hopelessness. It is a clinical category that describes inadequate relief from prior treatment, not a prediction of what is possible next.

Unlike antidepressants that primarily target monoamine neurotransmitter systems, ketamine works through a distinct biological mechanism. Its proposed antidepressant effects involve NMDA receptor antagonism in the glutamate system, along with downstream changes in BDNF signaling and synaptic plasticity (Abdallah et al., 2016). Landmark research and later randomized trials found that antidepressant effects may emerge within hours to days for some patients, rather than over the weeks often associated with conventional antidepressants (Berman et al., 2000; Murrough et al., 2013). To understand this mechanism in greater depth, our educational ketamine science resource offers a thorough overview of how ketamine interacts with the brain.

Off-Label Use and Individual Candidacy

It is essential to be precise: IV ketamine is used off-label for psychiatric indications. It is not FDA-approved for the treatment of depression. Published evidence has supported its use in some treatment-resistant mood disorders, while expert consensus also emphasizes careful screening, informed consent, monitoring, and attention to the limitations of the available evidence (Sanacora et al., 2017).

The clinical question for any individual patient is not whether ketamine works in general, but whether it is appropriate, safe, and likely to be beneficial for their specific situation. Our blog post on comparing ketamine versus SSRI treatment provides further context on how these approaches differ and when each may be considered.

Why Physician-Led Care Matters

This is where the physician you work with matters enormously. Dr. Sara Herman founded Soft Reboot Wellness after guiding more than 10,000 patients through anesthesia, pain management, and ketamine therapy. Her anesthesiology training and experience with ketamine administration inform the individualized dosing, physiological monitoring, and supportive care provided during each infusion.

Precision dosing, physiological monitoring, and proactive management of the infusion experience are central to a physician-led practice.

What an IV Ketamine Treatment Course May Involve

At Soft Reboot Wellness, an initial treatment course is individualized. Current protocols commonly involve four to six infusions scheduled weekly over four to six weeks, with treatment planning tailored to each patient’s symptoms, goals, and clinical response.

Sessions may run from approximately 45 minutes to two hours depending on the treatment protocol. During an infusion, patients may experience mild dissociation, visual or perceptual changes, and a dreamlike state. At subanesthetic doses, patients generally remain conscious, and the acute effects are expected to resolve before discharge (Sanacora et al., 2017).

Many patients find the experience more manageable when they are prepared and in a calm, supportive clinical environment. Our team helps patients understand what to expect during ketamine therapy and remains present throughout treatment to address discomfort if it arises.

Cost, Insurance, and the Infusion Experience

We hear two concerns consistently from patients considering IV ketamine in the Menlo Park and Peninsula area.

The first is cost. Insurance coverage for IV ketamine for psychiatric indications is inconsistent, and the out-of-pocket investment is real. We are transparent about our fees and discuss them fully during consultation. We also recognize that for patients who have spent years and significant resources pursuing mental health treatment without lasting relief, the cost-benefit calculation looks different. We respect each patient’s need to make that decision with full information.

The second concern is what the experience will feel like. Many people are unfamiliar with ketamine outside of its anesthetic or recreational contexts, and the prospect of an altered state can understandably feel anxiety-provoking. We address this directly in every consultation: the experience is time-limited, closely monitored, and discussed in advance.

Individualized Ongoing Treatment Planning

After the initial treatment course, some patients may benefit from periodic maintenance infusions to help sustain an antidepressant response over time. The frequency and duration of maintenance are individualized.

Results vary by individual, and we never guarantee specific outcomes. Our commitment is to provide an evidence-informed, carefully supervised experience and to partner with you in evaluating and adjusting your treatment plan. Please discuss all aspects of treatment planning with your provider, including how ketamine therapy may integrate with ongoing psychiatric care.

Whether you are in Menlo Park, Palo Alto, Redwood City, Mountain View, or elsewhere on the Peninsula, Soft Reboot Wellness is here to provide physician-level care for one of the most difficult mental health challenges patients face. We encourage you to schedule a consultation with our team.

FAQ

How quickly can I expect to feel a difference with IV ketamine?

Clinical studies have observed antidepressant effects as early as 24 hours after an infusion, though the timing and degree of response vary significantly between individuals (Murrough et al., 2013). Some patients respond gradually over the course of an initial treatment series.

Results vary by individual, and treatment is evaluated as a whole rather than based on the response to any single session.

Will I be awake during the infusion?

Yes. IV ketamine for depression is administered at subanesthetic doses, meaning patients generally remain conscious throughout treatment. You may experience dissociation or perceptual changes, but you are not expected to be asleep. Dr. Herman and the clinical team are present throughout each session.

Do I need to stop my current antidepressants to try ketamine?

Do not stop or change prescribed antidepressants on your own. Whether any medication adjustment is appropriate depends on your current regimen, medical history, and psychiatric history. Dr. Herman will review your medications carefully during intake and advise on any adjustments needed before treatment.

How do I know if I am a candidate for IV ketamine therapy?

A consultation with Dr. Herman is the appropriate starting point. In general, treatment-resistant depression commonly refers to depression that has not responded adequately to at least two antidepressant trials (McIntyre et al., 2023). Your complete medical and psychiatric history, current medications, and health status are evaluated during the intake process.

Key Takeaways

• IV ketamine engages the glutamate/NMDA receptor system through a mechanism distinct from conventional antidepressants and may produce rapid antidepressant effects for some patients with treatment-resistant depression.
• IV ketamine is used off-label for psychiatric indications and is not FDA-approved for depression.
• Soft Reboot Wellness in Menlo Park is led by Dr. Sara Herman, MD, a Harvard-trained anesthesiologist with experience guiding more than 10,000 patients through anesthesia, pain management, and ketamine therapy.
• A typical initial Soft Reboot Wellness protocol involves four to six infusions over four to six weeks, followed by individualized maintenance planning when appropriate.
• Results vary by individual; cost and the infusion experience are common concerns that Dr. Herman’s team addresses transparently during consultation.

Conclusion

For patients across the Bay Area who have not found adequate relief from standard depression treatments, IV ketamine therapy represents a biologically distinct, evidence-informed option that deserves serious consideration.

At Soft Reboot Wellness in Menlo Park, the focus is physician-led care that combines anesthesiology experience with individualized dosing and monitoring. If you are ready to explore whether IV ketamine therapy might be the right next step for your mental health, discuss your options with your provider and contact our team to schedule a consultation.

References

Abdallah, C. G., Adams, T. G., Kelmendi, B., Esterlis, I., Sanacora, G., & Krystal, J. H. (2016). Ketamine’s mechanism of action: A path to rapid-acting antidepressants. Depression and Anxiety, 33(8), 689–697.

Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, G. R., Charney, D. S., & Krystal, J. H. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351–354. https://doi.org/10.1016/S0006-3223(99)00230-9

McIntyre, R. S., Alsuwaidan, M., Baune, B. T., et al. (2023). Treatment-resistant depression: Definition, prevalence, detection, management, and investigational interventions. World Psychiatry, 22(3), 394–412. https://doi.org/10.1002/wps.21120

Murrough, J. W., Iosifescu, D. V., Chang, L. C., et al. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: A two-site randomized controlled trial. American Journal of Psychiatry, 170(10), 1134–1142. https://doi.org/10.1176/appi.ajp.2013.13030392

Sanacora, G., Frye, M. A., McDonald, W., et al. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399–405.

About Dr. Sara Herman

Dr. Sara Herman, MD, is a Harvard-trained anesthesiologist who founded Soft Reboot Wellness after guiding more than 10,000 patients through anesthesia, pain management, and ketamine therapy. Her clinical experience in ketamine administration, pharmacology, and safety shapes every aspect of her practice, from the precision of each infusion to the monitoring protocols that support patients throughout treatment.

At Soft Reboot Wellness, Dr. Herman applies this combination of academic training and hands-on experience to the care of patients with treatment-resistant depression, offering a physician-led approach grounded in individualized assessment and evidence-informed care.

Medical Disclaimer

The content provided on this page is for educational purposes only and does not constitute medical advice. IV ketamine therapy is used off-label for psychiatric indications and is not FDA-approved for the treatment of depression. Individual results vary, and not every patient will experience the same outcomes. This information should not replace a consultation with a qualified medical provider. Please discuss with your provider whether any treatment described here is appropriate for your specific health situation. Soft Reboot Wellness serves patients in Menlo Park, CA and the greater Bay Area.

The post IV Ketamine Therapy for Treatment-Resistant Depression in Menlo Park: A Physician’s Perspective appeared first on Soft Reboot Wellness.

Anxiety disorders are among the most common mental health conditions in the United States. National survey data estimate that 19.1% of U.S. adults experienced an anxiety disorder in the past year, and anxiety can significantly interfere with work, relationships, and daily life (National Institute of Mental Health [NIMH], n.d.).

For some people, standard approaches such as therapy and medication do not bring adequate relief. At Soft Reboot Wellness in Menlo Park, California, we have seen growing interest from Bay Area patients—including professionals managing high-stakes careers while living with debilitating anxiety—in whether IV ketamine therapy might offer another clinical option.

What Research Says About Ketamine for Anxiety

The evidence base for ketamine in anxiety disorders is younger and smaller than the evidence base for depression, but it is growing. Systematic reviews have identified early evidence of anxiety symptom reduction following ketamine treatment in some anxiety-spectrum conditions, while also emphasizing the limited number of trials, small samples, and need for further research (Whittaker et al., 2021; Tully et al., 2022).

Published research has included patients with generalized anxiety disorder, social anxiety disorder, and anxiety symptoms occurring alongside depression. A small randomized trial in social anxiety disorder found greater symptom reduction following ketamine than placebo, but this was a proof-of-concept study rather than definitive evidence for broad clinical use (Taylor et al., 2018).

The mechanisms proposed to explain these effects overlap with those studied in depression: NMDA receptor antagonism, glutamate-related signaling, and downstream changes associated with synaptic plasticity (Abdallah et al., 2016). To understand more about the biological pathways involved, see our overview of the science behind ketamine therapy and its impact on mental health. The full relationship between these mechanisms and anxiety outcomes remains an active area of research.

What the Evidence Does and Does Not Support

It is essential to be transparent about what the evidence currently supports. IV ketamine for anxiety is used off-label, meaning it is not FDA-approved for anxiety disorders. Ketamine itself is FDA-approved as an anesthetic, while its psychiatric uses require individualized clinical judgment and informed consent (National Institute on Drug Abuse, 2024).

The clinical trials are promising but smaller and more preliminary than the depression literature, and the durability of anxiolytic effects from ketamine remains an important area of investigation (Whittaker et al., 2021; Tully et al., 2022).

At Soft Reboot Wellness, Dr. Sara Herman, MD discusses the current state of the evidence with each patient considering ketamine for anxiety—not to discourage treatment, but to ensure that the decision is fully informed. Genuine informed consent is a non-negotiable part of how we practice medicine. Patients who want to learn more about how ketamine compares to other pharmacological options can also explore our post on comparing ketamine versus SSRI treatment.

Anxiety in High-Pressure Environments

Many people seeking care for anxiety have managed their symptoms for years through a combination of therapy, medication, and sheer willpower. The productivity culture of Silicon Valley can create particular pressures for people living with health anxiety, social anxiety, perfectionism-driven generalized anxiety, or panic symptoms that have been carefully hidden from colleagues and sometimes from family.

When standard treatments have provided only partial relief, patients may begin considering interventional options and looking for information that is clinically grounded and honest about the limits of current research.

What an IV Ketamine Treatment Course May Involve

IV ketamine treatment at Soft Reboot Wellness is individualized. The number, timing, and pacing of sessions are determined through consultation, clinical response, treatment goals, and ongoing assessment rather than a fixed protocol for every patient.

During an infusion, patients may experience dissociation, visual or perceptual changes, and a dreamlike state. These effects are time-limited and monitored throughout the session. Dr. Herman personally administers and monitors treatments, with attention to both physiological safety and the patient’s experience.

Many anxiety patients find the anticipation of the infusion experience anxiety-provoking, which is understandable. Our team helps patients prepare for what to expect during ketamine therapy before their first session, including practical questions about the treatment environment, recovery period, and ride-home planning.

Considering Stellate Ganglion Block for Anxiety

Soft Reboot Wellness also offers Stellate Ganglion Block (SGB) as a separate interventional option for some patients experiencing anxiety, hyperarousal, chronic stress, or sympathetic nervous system dysregulation.

Not every patient is a candidate for ketamine, SGB, or a combined approach. Dr. Herman evaluates each person’s medical history, symptoms, medications, and treatment goals before making recommendations. The decision about whether an interventional approach is appropriate belongs in a thorough consultation, not in a blog post.

Cost, Preparation, and Ongoing Care

Two barriers deserve acknowledgment.

First, some anxiety patients are concerned that ketamine’s dissociative effects will feel anxiety-inducing rather than therapeutic. The experience can be uncomfortable for some people, particularly those with significant anticipatory anxiety. Preparation gives patients the opportunity to ask questions, understand what may occur, and decide whether treatment feels appropriate for them.

Second, cost matters. Insurance coverage for IV ketamine for psychiatric indications is inconsistent, and the out-of-pocket investment requires honest planning. We discuss pricing transparently from the beginning.

Results vary by individual, and we do not make promises about anxiety outcomes. What we offer is physician oversight, honest evidence communication, and individualized care for patients who are ready to explore their options. Please discuss with your provider whether IV ketamine therapy is appropriate for your anxiety profile before making treatment decisions.

FAQ

What types of anxiety disorders might benefit from IV ketamine?

Published research has included patients with generalized anxiety disorder, social anxiety disorder, and anxiety symptoms occurring alongside depression. The research base remains limited, and whether ketamine is appropriate for a specific anxiety diagnosis depends on your individual history and is assessed during consultation with Dr. Herman.

How rapidly does IV ketamine work for anxiety?

Some research has observed anxiety symptom changes within the first day after treatment, although response timing varies substantially between individuals (Whittaker et al., 2021; Taylor et al., 2018). Some people experience more gradual change over an initial series of infusions. Treatment is evaluated as a whole rather than based on the response to any single session.

Could ketamine make my anxiety worse?

The dissociative experience during an infusion can be uncomfortable for some people, especially those with strong anticipatory anxiety. A careful intake evaluation, discussion of expectations, and ongoing monitoring help determine whether treatment is appropriate for your situation.

How does IV ketamine for anxiety compare to benzodiazepines?

They are distinct medications with different mechanisms, risks, dosing patterns, and clinical roles. Ketamine is administered in discrete, supervised infusion sessions rather than as a daily medication. Do not stop, start, or change prescribed medication without guidance from the clinician managing your care.

Should I combine IV ketamine with therapy for anxiety?

Many patients choose to continue working with an existing therapist or psychiatrist while considering ketamine treatment. Soft Reboot Wellness can coordinate care with outside providers when appropriate and with your consent. Discuss with your provider how any new treatment may fit into your existing care plan.

Key Takeaways

• IV ketamine has a growing, though still developing, evidence base for anxiety disorders and anxiety-spectrum symptoms.
• Ketamine for anxiety is used off-label and is not FDA-approved for anxiety disorders.
• Soft Reboot Wellness in Menlo Park offers physician-led ketamine therapy under Dr. Sara Herman, MD, with individualized monitoring throughout treatment.
• Treatment planning, including the number and timing of infusions, is individualized rather than based on a single fixed protocol.
• Results vary by individual; preparation, coordination with existing providers, and transparent cost discussions are part of the consultation process.

Conclusion

Anxiety that persists despite standard treatment is not a character flaw. For some patients, it may be appropriate to explore additional options with a qualified medical provider.

At Soft Reboot Wellness in Menlo Park, we bring physician-led care, individualized evaluation, and transparent evidence communication to conversations about IV ketamine therapy for anxiety. If you are a Bay Area patient living with significant anxiety despite medications and therapy, discuss your options with your provider and contact our team to explore whether a consultation is appropriate.

References

Abdallah, C. G., Adams, T. G., Kelmendi, B., Esterlis, I., Sanacora, G., & Krystal, J. H. (2016). Ketamine’s mechanism of action: A path to rapid-acting antidepressants. Depression and Anxiety, 33(8), 689–697.

National Institute on Drug Abuse. (2024, April 9). Ketamine. https://nida.nih.gov/research-topics/ketamine

National Institute of Mental Health. (n.d.). Any anxiety disorder. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

Taylor, J. H., Landeros-Weisenberger, A., Coughlin, C., et al. (2018). Ketamine for social anxiety disorder: A randomized, placebo-controlled crossover trial. Neuropsychopharmacology, 43(2), 325–333. https://doi.org/10.1038/npp.2017.194

Tully, J. L., Dahlén, A. D., Haggarty, C. J., Schiöth, H. B., & Brooks, S. (2022). Ketamine treatment for refractory anxiety: A systematic review. British Journal of Clinical Pharmacology, 88(10), 4412–4426.

Whittaker, E., Dadabayev, A. R., Joshi, S. A., & Glue, P. (2021). Systematic review and meta-analysis of randomized controlled trials of ketamine in the treatment of refractory anxiety spectrum disorders. Therapeutic Advances in Psychopharmacology, 11, 20451253211056743.

About Dr. Sara Herman

Dr. Sara Herman, MD, is a Harvard-trained, board-certified anesthesiologist and the founder of Soft Reboot Wellness. Her clinical experience in ketamine administration, pharmacology, and patient monitoring shapes each treatment plan, from dosing and preparation to physiological monitoring throughout the infusion experience.

At Soft Reboot Wellness, Dr. Herman provides a physician-led approach for patients exploring ketamine therapy, grounded in individualized assessment, informed consent, and evidence-informed care.

Medical Disclaimer

The content provided on this page is for educational purposes only and does not constitute medical advice. IV ketamine therapy for anxiety disorders is used off-label and is not FDA-approved for these indications. Individual results vary, and not every patient is an appropriate candidate. This information should not replace a consultation with a qualified medical provider. Please discuss with your provider whether any treatment described here is appropriate for your specific health situation. Soft Reboot Wellness serves patients in Menlo Park, CA and the greater Bay Area.

The post Ketamine Therapy for Anxiety Disorders: What the Research Says and Who May Benefit appeared first on Soft Reboot Wellness.

Post-traumatic stress disorder is often described as a disorder of memory—not because patients are imagining their trauma, but because the brain’s threat-processing systems can remain activated long after a traumatic event has passed. PTSD may involve intrusive memories, avoidance, hyperarousal, and persistent distress that affects work, relationships, and daily life (National Center for PTSD, n.d.).

Evidence-based PTSD care commonly includes trauma-focused psychotherapy, such as cognitive processing therapy, eye movement desensitization and reprocessing, or prolonged exposure, as well as selected medications when appropriate (U.S. Department of Veterans Affairs & U.S. Department of Defense, 2023). Still, some people continue to experience substantial symptoms despite prior treatment. If you’re wondering what PTSD really is and how it is diagnosed, our overview covers the fundamentals.

At Soft Reboot Wellness in Menlo Park, we offer IV ketamine therapy as an off-label option for PTSD. For Bay Area patients considering this approach, it is important to understand both the emerging research and its limitations.

What the Research Says About Ketamine for PTSD

The research base for ketamine in PTSD remains limited and mixed, though several studies have reported rapid reductions in PTSD symptom severity following IV ketamine infusion.

A randomized clinical trial of a single IV infusion found lower PTSD symptom severity 24 hours after treatment compared with an active placebo (Feder et al., 2014). A later randomized controlled trial of repeated infusions also found greater short-term improvement in PTSD symptom severity in the ketamine group than in the control group, but the study included only 30 participants and called for further research (Feder et al., 2021).

Recent systematic reviews and meta-analyses suggest ketamine may have potential for PTSD, while emphasizing heterogeneity across studies, limited sample sizes, and uncertainty around long-term outcomes (Almeida et al., 2024; Sicignano et al., 2024).

Ketamine acts on the NMDA receptor and glutamate system. Researchers are studying whether its effects on glutamate signaling, neuroplasticity, and memory processing may help explain observed changes in some PTSD symptoms. These proposed mechanisms remain under investigation and should not be treated as established explanations for every patient response (Abdallah et al., 2016). For a deeper look at the neuroscience involved, our educational ketamine science page provides an accessible overview.

Important Limits of the Current Evidence

It is critical to be precise about what the evidence supports and where its limits lie. IV ketamine for PTSD is off-label. It is not FDA-approved for PTSD or other psychiatric conditions; ketamine itself is FDA-approved as an anesthetic (National Institute on Drug Abuse, 2024).

The current 2023 VA/DoD Clinical Practice Guideline suggests against ketamine as a primary treatment for PTSD because available research has not yet established clear enough benefit relative to its risks and side-effect burden. The same guideline recommends trauma-focused psychotherapies over medication interventions for PTSD treatment (U.S. Department of Veterans Affairs & U.S. Department of Defense, 2023).

This does not make an individualized consultation meaningless. It does mean that careful clinical selection, informed consent, and honest discussion of realistic outcomes are essential.

At Soft Reboot Wellness, Dr. Sara Herman, MD conducts a detailed intake evaluation that includes PTSD symptoms, treatment history, current medications, and relevant medical and psychiatric factors before making any recommendation.

PTSD in High-Pressure Professional Environments

The profile of people seeking PTSD care in the Bay Area is diverse. Some are professionals in technology, finance, healthcare, or other high-pressure fields who have lived with symptoms for years while continuing to meet demanding responsibilities. Others are veterans, first responders, or people whose trauma symptoms have not responded adequately to prior therapy or medication.

High-functioning does not mean unaffected. Many people manage PTSD symptoms privately for a long time before seeking additional support. Understanding how ketamine infusion therapy is helping patients with PTSD can be a useful first step for those who are still weighing their options.

What IV Ketamine Treatment May Involve

Ketamine therapy for PTSD at Soft Reboot Wellness is not a quick fix, and treatment plans are individualized from the beginning.

A standard initial protocol involves four to six IV infusions over four to six weeks, with the number and timing adjusted according to clinical response. Dr. Herman personally administers and monitors infusion sessions, including vital-sign monitoring throughout treatment.

During an infusion, patients may experience dissociation, altered perception of time, or dreamlike imagery. These effects are temporary and generally resolve before discharge. Patients need a ride home after each session.

Our team prepares patients for what to expect during ketamine therapy before the first appointment, including practical questions about the treatment environment, recovery period, and post-session planning.

Ketamine, Psychotherapy, and Ongoing Care

A common question is whether ketamine therapy can be combined with psychotherapy for PTSD. This remains an area of active research and clinical interest.

Some patients choose to continue working with an existing psychologist, trauma therapist, or psychiatrist while considering ketamine treatment. Soft Reboot Wellness can coordinate care with outside providers when appropriate and with patient consent.

Ketamine should not be presented as a replacement for established trauma-focused care. Treatment decisions should consider the full clinical picture, including prior treatment, current supports, medical history, and individual goals.

For a broader overview of the medication’s proposed effects and treatment process, see what ketamine therapy actually does.

Considering Stellate Ganglion Block for PTSD

Soft Reboot Wellness also offers Stellate Ganglion Block (SGB) as a separate option that may be discussed for patients experiencing PTSD-related hyperarousal or sympathetic nervous system dysregulation.

SGB is not interchangeable with ketamine therapy, and not every patient is a candidate for either treatment. Current VA/DoD guidance finds insufficient evidence to recommend for or against SGB for PTSD, so candidacy and expectations should be discussed carefully during consultation (U.S. Department of Veterans Affairs & U.S. Department of Defense, 2023).

Patients interested in learning more can review our overview of Stellate Ganglion Block for PTSD.

Schedule, Cost, and Practical Considerations

Two practical barriers are worth addressing directly.

The first is schedule. An initial infusion series requires time for appointments, recovery, and follow-up planning. Soft Reboot Wellness works to offer appointment availability that accommodates demanding professional schedules.

The second is cost. IV ketamine therapy for PTSD is off-label, and insurance coverage is not standard. We discuss pricing transparently during consultation so patients can make informed financial decisions.

Results vary by individual, and we do not make promises about PTSD outcomes. Our role is to provide physician-led care, transparent evidence communication, and individualized assessment for patients exploring their options.

FAQ

Is ketamine therapy for PTSD covered by insurance?
Insurance coverage for IV ketamine therapy for PTSD is not standard and varies by plan. Our team discusses fees and practical considerations during consultation so you can make an informed decision.

What PTSD symptoms does ketamine specifically target?
Clinical studies generally assess changes in overall PTSD symptom severity. Research has not established that ketamine will improve any specific symptom for every patient. Individual responses can vary.

Can I continue my current PTSD medications during ketamine therapy?
Do not stop or change prescribed medications on your own. Dr. Herman reviews your complete medication list during intake and will discuss whether any changes or additional considerations are appropriate before treatment.

How does ketamine for PTSD differ from ketamine for depression?
The infusion process may appear similar, but PTSD and depression involve different symptom patterns and evidence bases. Some people experience both conditions, and treatment planning should account for the full clinical picture rather than treating diagnoses in isolation.

Are there people with PTSD who should not receive IV ketamine therapy?
Yes. Candidacy depends on a person’s medical history, psychiatric history, current medications, trauma history, and other individual factors. A thorough medical and psychiatric review helps determine whether ketamine therapy is appropriate.

Key Takeaways

• IV ketamine for PTSD is off-label and is not FDA-approved for PTSD.
• Small randomized trials and systematic reviews suggest potential short-term symptom improvement, but the evidence remains limited and mixed.
• Current VA/DoD guidance prioritizes trauma-focused psychotherapy for PTSD and suggests against ketamine as a primary PTSD treatment.
• Soft Reboot Wellness offers physician-led IV ketamine therapy under Dr. Sara Herman, MD, with individualized monitoring and candidacy review.
• A typical initial Soft Reboot Wellness protocol involves four to six infusions over four to six weeks, with timing personalized to clinical response.
• Results vary by individual, and coordination with existing mental health providers is encouraged.

Conclusion

PTSD that persists despite standard treatment deserves serious, individualized clinical attention. For some people, a consultation about IV ketamine therapy may be part of exploring the full range of available options—but it should include a clear understanding of current evidence, established PTSD treatments, and the limits of emerging interventions.

At Soft Reboot Wellness in Menlo Park, Dr. Sara Herman provides physician-led evaluation and monitoring for patients considering IV ketamine therapy. To discuss whether a consultation may be appropriate, contact our team today.

References

Abdallah, C. G., Adams, T. G., Kelmendi, B., Esterlis, I., Sanacora, G., & Krystal, J. H. (2016). Ketamine’s mechanism of action: A path to rapid-acting antidepressants. Depression and Anxiety, 33(8), 689–697.

Almeida, T. M., Lacerda da Silva, U. R., Pires, J. P., Borges, I. N., Martins, C. R. M., Cordeiro, Q., & Uchida, R. R. (2024). Effectiveness of ketamine for the treatment of post-traumatic stress disorder: A systematic review and meta-analysis. Clinical Neuropsychiatry, 21(1), 22–31. https://doi.org/10.36131/cnfioritieditore20240102

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. https://doi.org/10.1001/jamapsychiatry.2014.1435

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. https://doi.org/10.1176/appi.ajp.2020.20050596

National Center for PTSD. (n.d.). PTSD basics. https://www.ptsd.va.gov/understand/what/ptsd_basics.asp

National Institute on Drug Abuse. (2024, April 9). Ketamine. https://nida.nih.gov/research-topics/ketamine

Sicignano, D. J., Kurschner, R., Weisman, N., Sedensky, A., Hernandez, A. V., & White, C. M. (2024). The impact of ketamine for treatment of post-traumatic stress disorder: A systematic review with meta-analyses. Annals of Pharmacotherapy, 58(7), 715–723.

U.S. Department of Veterans Affairs & U.S. Department of Defense. (2023). VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder. https://www.ptsd.va.gov/professional/treat/txessentials/clinician_guide_meds.asp

About Dr. Sara Herman

Dr. Sara Herman, MD, is a Harvard-trained anesthesiologist who founded Soft Reboot Wellness after guiding more than 10,000 patients through anesthesia and ketamine therapy. Her clinical experience in ketamine administration, pharmacology, and patient monitoring shapes each treatment plan, from individualized dosing to physiological monitoring throughout the infusion experience.

At Soft Reboot Wellness, Dr. Herman provides a physician-led approach for patients exploring ketamine therapy, grounded in individualized assessment, informed consent, and evidence-informed care.

Medical Disclaimer

The content provided on this page is for educational purposes only and does not constitute medical advice. IV ketamine therapy for PTSD is used off-label and is not FDA-approved for this indication. Individual results vary, and not every patient is an appropriate candidate. This information should not replace a consultation with a qualified medical provider. Please discuss with your provider whether any treatment described here is appropriate for your specific health situation. Soft Reboot Wellness serves patients in Menlo Park, CA and the greater Bay Area.

The post Ketamine Therapy for PTSD in Silicon Valley: An Evidence-Based Overview appeared first on Soft Reboot Wellness.

As IV ketamine therapy has become more widely available across the Bay Area, patients may encounter meaningful differences in the clinical environments offering it. The qualifications of the clinician responsible for screening, administering, and monitoring treatment are important considerations.

For people in Silicon Valley considering ketamine therapy for depression, PTSD, or anxiety, it is reasonable to ask who will conduct the medical evaluation, monitor the infusion, and respond if a patient needs additional support during treatment.

At Soft Reboot Wellness in Menlo Park, care is physician-led. Dr. Sara Herman, MD, is a Harvard-trained, board-certified anesthesiologist who has guided more than 10,000 patients through anesthesia, pain management, and ketamine therapy.

What Anesthesiology Training Brings to Ketamine Care

Anesthesiologists are physicians whose specialty training centers on anesthesia, medication effects, patient physiology, monitoring, and responding to complications during procedures. That background is relevant to ketamine treatment because ketamine can affect perception, consciousness, blood pressure, heart rate, and other physiological functions.

Guidelines for moderate procedural sedation emphasize appropriate patient assessment, monitoring, and the ability to recognize and respond when sedation becomes deeper than intended (American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, 2018).

At Soft Reboot Wellness, Dr. Herman’s clinical background informs the practice’s physician-led care model, including individualized screening, treatment planning, and monitoring throughout the infusion experience.

Ketamine Safety Requires Individual Assessment

Ketamine’s clinical risks are real, even though serious adverse events have been uncommon in published studies of low-dose IV ketamine for treatment-resistant depression. Common acute effects can include dissociation, perceptual changes, nausea, dizziness, and temporary increases in blood pressure or heart rate (Wan et al., 2015).

The American Psychiatric Association’s consensus statement on ketamine for mood disorders emphasizes careful assessment of medical and psychiatric history, informed consent, monitoring, and clinician readiness to address adverse effects (Sanacora et al., 2017).

At Soft Reboot Wellness, treatment planning begins with a thorough review of medical history, psychiatric history, current medications, cardiovascular considerations, and treatment goals. This is more than a questionnaire. It is an individualized medical evaluation designed to help determine whether ketamine therapy is appropriate.

For a closer look at the treatment process itself, read what ketamine therapy actually does.

Monitoring During an IV Ketamine Infusion

During IV ketamine treatment, patients may experience a dreamlike or dissociative state. They may also notice altered perception of time, visual changes, or temporary emotional intensity. These experiences can be expected effects of ketamine, but each patient’s experience is different.

Soft Reboot Wellness describes its infusion model as physician-supervised and monitored, with Dr. Herman personally involved in clinical administration and monitoring. Vital signs are tracked during treatment, and patients remain in the office until they are ready for discharge.

Patients can learn more about the practical details of a session in our guide to what to expect during ketamine therapy.

Physician Oversight and Treatment Decisions

Physician-led care is not only about what happens during an infusion. It also involves decisions before and after treatment.

Ketamine may not be appropriate for everyone. Medical conditions, psychiatric history, medication interactions, substance-use history, cardiovascular factors, and other individual considerations can affect candidacy. These decisions should be made through a careful medical and psychiatric review rather than a standardized protocol alone.

No clinician or setting can guarantee a particular treatment outcome. However, patients should understand who is responsible for clinical decision-making, how the practice approaches monitoring, and how concerns are addressed throughout treatment.

Understanding Fees and What Care Includes

Physician-led care may involve a different fee structure than other treatment models because clinical evaluation, ongoing monitoring, and individualized treatment planning take time and expertise.

Patients should feel comfortable asking what a treatment fee includes, who will be present during the infusion, how medical concerns are handled, and what follow-up is available. Soft Reboot Wellness discusses pricing during consultation so patients can make informed decisions without relying only on line-item comparisons.

Results vary by individual. The goal of careful oversight is not to promise a specific outcome, but to support appropriate selection, monitoring, and treatment adjustments when clinically indicated.

Ketamine Therapy and Stellate Ganglion Block

Soft Reboot Wellness also offers Stellate Ganglion Block treatments. SGB is a separate interventional procedure that uses local anesthetic near a group of sympathetic nerves in the neck.

The practice performs SGB with real-time ultrasound guidance. Dr. Herman’s anesthesiology background includes patient monitoring, airway management, and ultrasound-guided procedural experience relevant to this type of care.

Ketamine therapy and SGB are distinct interventions with different procedures, evidence bases, and candidacy considerations. Some patients may be appropriate candidates for one option and not the other. The right approach depends on an individual clinical evaluation.

Questions to Ask When Comparing Ketamine Providers

If you are evaluating ketamine providers in Menlo Park, Palo Alto, Redwood City, or elsewhere on the Peninsula, consider asking:

• Who will conduct my medical and psychiatric evaluation?
• Who will administer and monitor my infusion?
• What vital signs or other clinical measures are monitored during treatment?
• How does the practice screen for medical or psychiatric contraindications?
• What happens if I experience distress, nausea, elevated blood pressure, or another unexpected effect?
• How will treatment decisions be adjusted if my response differs from expectations?
• How does the practice coordinate with my existing psychiatrist, therapist, or primary care provider?

At Soft Reboot Wellness, we welcome these questions. Patients can also review our ketamine therapy FAQ information before consultation.

FAQ

What does it mean that Dr. Herman is a Harvard-trained anesthesiologist?

Dr. Herman completed anesthesiology residency training at Harvard Medical School’s Brigham and Women’s Hospital and completed a cardiothoracic anesthesia fellowship at Columbia University Medical Center. Her training includes anesthesia, pharmacology, patient monitoring, and procedural care.

Is ketamine safer when administered by an anesthesiologist?

No clinician or treatment setting can guarantee safety. Ketamine can cause temporary changes in blood pressure, heart rate, perception, and consciousness, which makes appropriate screening and monitoring important (Wan et al., 2015). An anesthesiologist’s training is directly relevant to medication administration, physiological monitoring, airway management, and responding to changes during a procedure. Patients should ask any provider about their training, monitoring practices, and emergency-readiness protocols.

Does it matter what type of physician is overseeing my ketamine infusion?

It is reasonable to ask about a clinician’s training, experience with ketamine, approach to psychiatric and medical screening, and role during the infusion. Different physicians may bring different backgrounds to ketamine care. Patients should understand who is responsible for treatment decisions and monitoring before beginning a program.

How does physician oversight affect ketamine patient selection?

Patient selection involves reviewing medical history, psychiatric history, medications, cardiovascular considerations, prior treatment response, and individual goals. A physician-led evaluation can help identify factors that may affect candidacy, monitoring needs, or treatment planning.

Why does Soft Reboot Wellness also offer Stellate Ganglion Block?

SGB is an image-guided nerve block procedure that Soft Reboot Wellness performs with real-time ultrasound guidance. Dr. Herman’s anesthesiology background is relevant to the procedural assessment, technique, and monitoring involved in SGB care.

Key Takeaways

• Ketamine treatment requires individualized medical and psychiatric assessment, appropriate monitoring, and informed consent.
• Anesthesiology training is relevant to ketamine administration because it includes pharmacology, physiological monitoring, procedural care, and response to changes during treatment.
• Dr. Sara Herman, MD, is a Harvard-trained, board-certified anesthesiologist with experience guiding more than 10,000 patients through anesthesia, pain management, and ketamine therapy.
• Soft Reboot Wellness provides physician-led IV ketamine therapy and ultrasound-guided Stellate Ganglion Block in Menlo Park.
• Patients should ask clear questions about screening, monitoring, clinician credentials, costs, and coordination with existing providers before starting treatment.
• Results vary by individual, and no provider should guarantee a specific outcome.

Conclusion

Choosing a ketamine provider is an important part of deciding whether treatment is right for you. A thoughtful consultation should include discussion of your medical and psychiatric history, current medications, treatment goals, potential risks, and the clinical environment in which care is delivered.

At Soft Reboot Wellness in Menlo Park, Dr. Sara Herman provides physician-led evaluation and monitoring for patients considering IV ketamine therapy. To learn more or schedule a consultation, reach out to our team today.

References

American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, & Society of Interventional Radiology. (2018). Practice guidelines for moderate procedural sedation and analgesia 2018. Anesthesiology, 128(3), 437–479. https://doi.org/10.1097/ALN.0000000000002043

National Institute on Drug Abuse. (2024, April 9). Ketamine. https://nida.nih.gov/research-topics/ketamine

Sanacora, G., Frye, M. A., McDonald, W., Mathew, S. J., Turner, M. S., Schatzberg, A. F., Summergrad, P., Nemeroff, C. B., & American Psychiatric Association Council of Research Task Force on Novel Biomarkers and Treatments. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399–405.

Wan, L.-B., Levitch, C. F., Perez, A. M., Brallier, J. W., Iosifescu, D. V., Charney, D. S., Murrough, J. W., & Mathew, S. J. (2015). Ketamine safety and tolerability in clinical trials for treatment-resistant depression. The Journal of Clinical Psychiatry, 76(3), 247–252. https://doi.org/10.4088/JCP.13m08852

About Dr. Sara Herman

Dr. Sara Herman, MD, is a Harvard-trained, board-certified anesthesiologist and founder of Soft Reboot Wellness. She has guided more than 10,000 patients through anesthesia, pain management, and ketamine therapy.

Her clinical background informs Soft Reboot Wellness’s approach to individualized assessment, ketamine administration, physiological monitoring, and ultrasound-guided Stellate Ganglion Block procedures.

Medical Disclaimer

The content provided on this page is for educational purposes only and does not constitute medical advice. IV ketamine therapy is used off-label for psychiatric indications and is not FDA-approved for the treatment of depression, PTSD, or anxiety disorders. Individual results vary, and not every patient is an appropriate candidate. This information should not replace a consultation with a qualified medical provider. Please discuss with your provider whether any treatment described here is appropriate for your specific health situation. Soft Reboot Wellness serves patients in Menlo Park, CA and the greater Bay Area.

The post Why Physician-Led Ketamine Therapy Matters: The Case for Choosing a Board-Certified Anesthesiologist appeared first on Soft Reboot Wellness.

What Ketamine Does in the Brain

Ketamine’s primary action is on NMDA receptors (N-methyl-D-aspartate receptors), which are part of the glutamate system (the brain’s main excitatory neurotransmitter network). By temporarily blocking these receptors, ketamine triggers a cascade of downstream effects that standard antidepressants (which work through serotonin and norepinephrine) do not produce (National Institutes of Health).

The most clinically important of these downstream effects is a rapid increase in synaptic plasticity: the brain’s ability to strengthen and reorganize connections between neurons. In depression, anxiety, and PTSD, neural circuits involved in mood regulation, fear processing, and self-referential thinking tend to become rigid and entrenched. Ketamine disrupts that rigidity. Research shows it promotes neuroplasticity in ways that standard antidepressants approximate only after weeks of daily dosing, and ketamine can produce this effect within hours of a single infusion (National Institutes of Health).

Ketamine also increases BDNF (brain-derived neurotrophic factor), a protein that supports neuron survival, growth, and the formation of new synaptic connections (National Institutes of Health). BDNF is often depleted in people with depression, and restoring it is thought to be one of the mechanisms through which antidepressant effects are sustained beyond the immediate post-infusion period. Additionally, emerging research published in Nature suggests ketamine may interact with the brain’s opioid system as a secondary mechanism, pointing to a treatment with more than one pathway of therapeutic action (Nature).

What Ketamine Therapy Does Clinically

The clinical picture that emerges from research is striking. Ketamine produces rapid and significant antidepressant effects, often within hours, in patients who have not responded to multiple prior treatments (National Institutes of Health). For patients with treatment-resistant depression, anxiety, or PTSD, this speed is not a minor detail. It represents a fundamentally different experience of treatment: rather than waiting six to eight weeks to know whether a medication is working, patients often know within days.

The effects of a single infusion are real but typically time-limited, most patients experience meaningful symptom relief for days to weeks following the first session. This is why a series of infusions is the standard approach rather than a single treatment. Research shows that both single and repeated ketamine infusions can treat depression and related conditions, with repeated infusions extending the duration and depth of benefit (American Journal of Psychiatry). Our standard induction protocol at Soft Reboot Wellness involves four to six IV infusions over four to six weeks, personalized to your clinical response.

Ketamine-assisted psychotherapy (KAP) pairs infusions with structured preparation and integration work, and research supports the combination producing more durable outcomes than ketamine alone (National Institutes of Health). Our KAP program includes a preparation session, two 2-hour in-office infusion sessions, and integration coaching with a certified psychedelic integration coach.

What the Experience Is Like

Patients considering ketamine therapy understandably want to know what they are signing up for on a sensory level. The honest answer is that experiences vary, but certain qualities are consistent.

During an IV ketamine infusion, patients typically notice the onset of effects within minutes. The experience often includes a sense of mental quieting, a loosening of the grip of ordinary anxious or depressive thought patterns. Some patients describe mild perceptual shifts: altered time perception, a floating or dreamlike quality, or vivid inner imagery. Some experience emotional content that feels meaningful or revealing. Others find it largely calm and neutral.

What the experience is not: frightening in the way many patients expect. The dissociative quality that makes some people hesitant tends, in practice, to feel more like relief than threat for most patients in a supervised clinical setting. Dr. Sara Herman personally monitors all infusion sessions at our Menlo Park clinic. Vital signs are tracked continuously. The altered state resolves fully before patients leave, typically within an hour of the infusion ending, and patients are required to have a ride home.

The 48 to 72 hours following a session are considered particularly significant for integration: the neuroplastic window opened by the infusion is still active, and this is an optimal time for reflection, journaling, and the kind of internal work our integration coaching is designed to support.

What Ketamine Therapy Does Not Do

Being clear about limitations is as important as explaining the evidence. Ketamine therapy is not a cure, and we do not present it as one. Results vary by individual, and some patients do not respond to ketamine in the way they hope. Some patients require ongoing maintenance infusions, single booster sessions typically scheduled three weeks to three months after the initial series, to sustain the benefits they achieve during induction.

Ketamine’s mental health applications are also off-label. The medication has been FDA-approved as an anesthetic since 1970, and its safety profile at therapeutic doses is well-established. But its use for depression, anxiety, and PTSD has not received formal FDA approval for those specific psychiatric indications, which means insurance coverage is inconsistent. We are transparent about this from the start of the process, contact our team at 650-419-3330 or hello@softrebootwellness.com before your consultation to discuss the financial realities clearly.

Ketamine is also not appropriate for everyone. Patients with certain psychiatric histories, active substance use disorders, or specific medical conditions may not be suitable candidates. Every patient undergoes a thorough medical and psychiatric review before any treatment is recommended, and we will tell you honestly if we think a different approach is better suited to your situation.

How Soft Reboot’s Approach Shapes the Outcome

The same medication administered in different contexts produces different results. This is not a marketing claim. It is a documented feature of how ketamine works. Research on KAP shows that the integration of psychotherapy with infusion treatment improves outcomes relative to infusion alone, which is why our clinical model is built around that integration rather than treating it as optional (National Institutes of Health).

Dr. Herman’s credentials reflect this philosophy directly. She holds an Advanced Certificate in Psilocybin-Assisted Therapy from the Integrative Psychiatry Institute, has completed training in Internal Family Systems (IFS) combined with ketamine-assisted psychotherapy, and has personally guided more than 10,000 patients through anesthesia, pain management, and ketamine therapy over her career. Dr. Natasha, our board-certified anesthesiologist who trained at UCSF, brings additional clinical depth to the monitoring and safety dimension of every session.

We also use the Osmind EHR and mood-tracking platform to document your progress throughout treatment. This means your response is tracked objectively, not reconstructed from memory at occasional check-ins, and can be reviewed alongside your existing treatment team if you have one. We actively coordinate with outside providers, with your consent, because we believe integrative care produces better outcomes than any single clinic working in isolation. You can learn more on our frequently asked questions page.

Frequently Asked Questions

How long does the antidepressant effect of ketamine last after an infusion series? For most patients completing a standard induction series, the reduction in depressive symptoms lasts approximately five weeks on average, with a range of roughly three weeks to two months. Individual responses vary considerably. Maintenance infusions, single booster sessions, can be used to sustain the benefit when symptoms begin to return, and some patients find they need these infrequently while others use them more regularly.

Does ketamine therapy work better for some conditions than others? The strongest evidence base exists for treatment-resistant depression and PTSD, both of which are conditions we treat at Soft Reboot Wellness. There is also meaningful clinical evidence for ketamine’s effectiveness in anxiety. We assess the fit between your diagnosis and the available evidence during your consultation, so our recommendation is grounded in what the research actually supports for your specific presentation.

Will I remember my infusion sessions? Most patients retain some memory of the experience, though the altered quality of consciousness during infusion means those memories may be impressionistic rather than sequential. Patients are encouraged to journal or reflect in the hours and days following their session, while the experience is still accessible. Our integration coaching component is specifically designed to help you make sense of and work with whatever arises.

Can ketamine therapy be used alongside talk therapy or other psychiatric treatment? Yes, and we actively encourage it. Ketamine therapy works well as a complement to ongoing psychotherapy, many patients find their therapy deepens during and after a ketamine series, precisely because the neuroplastic window makes habitual thought patterns more available for examination. We coordinate with outside therapists and psychiatrists with your consent throughout your treatment.

Key Takeaways

• Ketamine works through NMDA receptor blockade in the glutamate system, triggering rapid neuroplasticity and BDNF increases that standard antidepressants do not produce on the same timeline.
• Clinical research documents significant antidepressant and anti-PTSD effects that often appear within hours, a fundamentally different experience from the weeks-long timeline of standard medications.
• The experience during infusion is time-limited, monitored, and for most patients more calming than distressing.
• Ketamine is an off-label treatment for mental health conditions; insurance coverage is inconsistent, and candidacy is determined individually through a medical and psychiatric review.
• Results vary by individual; combining ketamine with integration support, as in our KAP program, is associated with more durable outcomes.

Understanding what ketamine therapy does is the first step toward knowing whether it might be right for you. We are glad to continue that conversation in person. Call us at 650-419-3330 or email hello@softrebootwellness.com to schedule a consultation at our Menlo Park clinic.

References

1. National Institutes of Health. Ketamine works by blocking NMDA receptors in the glutamate system, producing rapid antidepressant effects through a mechanism distinct from traditional antidepressants. https://pmc.ncbi.nlm.nih.gov/articles/PMC5148235/
2. National Institutes of Health. NMDA receptors play a central role in synaptic plasticity and are the primary target of ketamine’s antidepressant action. https://pmc.ncbi.nlm.nih.gov/articles/PMC9965111/
3. National Institutes of Health. Ketamine has been shown to increase brain-derived neurotrophic factor (BDNF), a protein essential for neuron growth and long-term mood regulation. https://pubmed.ncbi.nlm.nih.gov/39684808/
4. Nature. Research suggests ketamine may also produce antidepressant effects by interacting with the brain’s opioid system, pointing to multiple mechanisms of action. https://www.nature.com/articles/s41591-025-03800-w
5. National Institutes of Health. Ketamine has demonstrated rapid and significant antidepressant effects in clinical studies, often working within hours when traditional medications take weeks. https://www.nimh.nih.gov/news/science-updates/2024/new-hope-for-rapid-acting-depression-treatment
6. American Journal of Psychiatry. Research shows that both single and repeated ketamine infusions can treat treatment-resistant depression, with maintenance infusions extending the duration of benefit. https://psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070834
7. National Institutes of Health. Research supports the integration of psychotherapy with ketamine treatment, showing that the combination may produce more durable and meaningful outcomes than ketamine alone. https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/

Medical Disclaimer: The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy should only be pursued under the supervision of a licensed medical provider familiar with your full medical and psychiatric history. Individual results vary. Off-label treatments like IV ketamine for mental health conditions carry risks that should be discussed thoroughly with a qualified provider before beginning. 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.

Reviewed by Dr. Sara Herman

The post What Does Ketamine Therapy Actually Do? A Complete Guide appeared first on Soft Reboot Wellness.

Before You Ever Arrive: The Intake and Consultation Process

Ketamine therapy at Soft Reboot Wellness begins by calling us at 650-419-3330 or emailing hello@softrebootwellness.com. We send you an intake packet to complete, Dr. Herman reviews it, and then determines whether to schedule a consultation. That consultation covers your mental health history, prior treatments, current medications, and what you are hoping to address.

If you have an existing psychiatrist, therapist, or prescriber, we contact them, with your explicit consent, to coordinate on your treatment plan. We are not a replacement for your existing care team; we work alongside them. For patients who do not have outside providers, we work independently and document everything through the Osmind EHR platform, which also includes a mood-tracking app you will use throughout treatment. You can get a detailed overview of what to expect from our clinical process on our dedicated page.

The medical and psychiatric consultation comes before any infusion is scheduled. Dr. Sara Herman or Dr. Natasha reviews your full history to determine whether IV ketamine therapy is appropriate for your specific situation. Not every patient who comes to us is a good candidate, and we will tell you honestly if we do not think we are the right fit. Ketamine is an off-label treatment for mental health conditions, meaning the FDA has not formally approved it for specific psychiatric diagnoses, and candidacy depends on a careful individual assessment.

The Day of Your Infusion

Plan to have someone drive you to and from your appointment. You will not be able to drive yourself home, this is a non-negotiable clinical requirement, not an abundance of caution. Most patients find it helpful to think of the infusion day as a rest day: clear your schedule afterward, have light plans for the evening, and arrive without rushing.

Eat a light meal two to four hours before your infusion and avoid alcohol for at least 24 hours prior. Wear comfortable clothing. You are welcome to bring music, many patients find it significantly shapes the quality of their experience, and we have recommendations if you want them. Our post on music as medicine explores how sound can support the ketamine experience.

When you arrive at our Menlo Park clinic, you will be settled into a comfortable infusion space. Dr. Herman personally administers all IV lines and monitors all sessions from start to finish. A small IV catheter is placed, typically in the arm, and the infusion begins at a slow, controlled rate. Vital signs are monitored continuously throughout the session.

During the Infusion

Effects begin within minutes of infusion onset. What you experience will be personal, no two sessions are identical, and no two patients describe them in quite the same way. That said, certain qualities are consistent enough to be worth describing.

Most patients notice a shift in how their thoughts feel. The relentless quality of anxious or depressive rumination, the loops, the self-criticism, the weight of it, typically softens. Some patients describe it as the mental noise turning down. There may be perceptual changes: a dreamlike quality, altered sense of time, mild visual patterns with eyes closed, or a sense of the mind becoming loosened from ordinary reference points. Some patients experience emotional content, memories, feelings, or imagery that feels significant. Others find the experience largely calm and interior.

The dissociation that many patients fear beforehand tends, in practice, to feel less frightening than anticipated. You remain aware that you are in a clinical setting, that the experience is temporary, and that the care team is present throughout. Research confirms that side effects from a single antidepressant dose of IV ketamine are mild and brief, supporting its safety profile in clinical settings (National Institutes of Health). The session typically runs between 45 minutes and two hours depending on your protocol, and the acute effects resolve fully before you are discharged.

For patients in our ketamine-assisted psychotherapy (KAP) program, the in-office infusion sessions are two hours each. The extended time is designed to allow for a fuller experience and a gentler return, with space for initial reflection before you leave.

Immediately After the Session

The hour following infusion is a transition period. Most patients feel relaxed, occasionally tired, and emotionally open. Some feel moved by what arose during the session; others feel simply quiet. You will rest in the clinic space until you are fully alert and your vital signs have returned to baseline, this typically takes 30 to 60 minutes following the end of the infusion.

After your session, your integration coach checks in before discharge. You go home with your designated driver, and we recommend a gentle evening: no major decisions, no demanding social commitments, no alcohol.

The Integration Window: 48 to 72 Hours After

Research shows that 48 to 72 hours after a ketamine session is the optimal window for integration, the period during which the neuroplastic changes initiated by the infusion are most active and the brain is most receptive to new patterns (American Journal of Psychiatry). This is not the time to push through a demanding workload or ignore what arose during the session. It is the time to pay attention.

Integration coaching sessions are timed around this window. We use the Internal Family Systems (IFS) framework, a model in which different internal states, memories, and protective patterns are understood as distinct “parts” of the self, to help patients engage with whatever surfaced during the infusion in a structured, compassionate way. Dr. Herman has completed training in IFS combined with ketamine-assisted psychotherapy specifically because we believe this window, when used well, is where much of the lasting therapeutic work happens.

For all patients, we encourage journaling, light physical movement, and continuing to log mood data in the Osmind app so we can track your response across the full induction series. Our integration inspirations page offers additional resources for making the most of this period.

What the Full Induction Series Looks Like

A standard induction series at Soft Reboot Wellness involves four to six IV infusions over four to six weeks. Research shows that starting with a series of six infusions produces longer-lasting symptom reduction than fewer sessions, though we calibrate the specific protocol to your clinical response, some patients need fewer, some may benefit from more (American Journal of Psychiatry). Sessions are scheduled once weekly.

The reduction in depressive or PTSD symptoms following the induction series typically lasts approximately five weeks on average, with a range of three weeks to two months for most patients. Subsequent single maintenance infusions, booster sessions, may be used to sustain symptom improvement, typically scheduled anywhere from three weeks to three months after the initial series depending on your individual response pattern.

Addressing the Scheduling and Cost Questions

A ketamine infusion session does not require days of recovery. Most patients return to their normal schedules the following day. We offer appointment times that accommodate demanding professional schedules, because we work primarily with Silicon Valley professionals whose time constraints are real.

IV ketamine for mental health is an off-label treatment, and insurance coverage is inconsistent. We do not want cost to be a surprise, contact us at 650-419-3330 or hello@softrebootwellness.com before your consultation to discuss what the financial commitment looks like for your specific treatment plan. Results vary by individual, and we encourage you to discuss your options with your current providers before beginning.

Frequently Asked Questions

What if I have a difficult experience during an infusion? Challenging experiences during ketamine infusions do occur for some patients, and our clinical team is prepared for them. Dr. Herman monitors all sessions in person and can adjust the infusion rate or intervene if needed. Patients are never left alone during a session. If difficult emotional content arises, this is sometimes part of the therapeutic process, particularly for patients with trauma histories, and our integration coaching is designed to help you work with it rather than simply wait it out.

How will I feel the day after my first infusion? Most patients feel rested or emotionally lighter the day after. Some feel temporarily more fatigued than usual, particularly after their first session. A small number of patients experience mild headache or nausea in the hours immediately following infusion, though these typically resolve quickly. The day-after experience tends to improve across the induction series as the body adjusts.

Can I go back to work the day after a session? For most patients, yes. The acute effects resolve fully before you leave the clinic, and most patients function normally the following day. We recommend not scheduling high-stakes professional obligations on the infusion day itself or the immediate evening after, but the following morning is generally fine.

How do I know if the treatment is working? We track your response through the Osmind mood-tracking app throughout your induction series, so your progress is documented rather than relying on subjective memory. You and our care team review this data together. Meaningful symptom changes typically emerge across the first two to four infusions, though the timing varies between individuals.

What happens at the end of the induction series? At the end of your induction series, we review your mood data and clinical response with you and discuss next steps. Some patients do well without further treatment for an extended period. Others find that occasional maintenance infusions help sustain the gains they have made. We work with you and your outside providers, if applicable, to develop a follow-up plan that fits your actual response pattern.

Key Takeaways

• Ketamine therapy at Soft Reboot Wellness begins with a thorough intake and consultation before any infusion is scheduled; not everyone who inquires is an appropriate candidate.
• Infusion sessions are personally administered and monitored by Dr. Herman; you will need a driver and should plan the treatment day as a rest day.
• The acute experience, altered perception, mental quieting, is temporary and resolves fully before discharge; for most patients it is calmer than anticipated.
• The 48 to 72 hours following infusion are the optimal integration window; our KAP program is specifically structured around this period.
• A standard induction series involves four to six infusions over four to six weeks, with maintenance sessions available afterward based on individual response.

Knowing what to expect removes one of the largest barriers to starting. If reading this has moved you closer to a decision, we are ready to continue the conversation. Call us at 650-419-3330 or email hello@softrebootwellness.com to schedule your consultation at our Menlo Park clinic.

References

1. National Institutes of Health. NIH research confirms that side effects from a single antidepressant dose of intravenous ketamine are mild and brief, supporting its safety profile in clinical settings. https://www.nih.gov/news-events/news-releases/side-effects-mild-brief-single-antidepressant-dose-intravenous-ketamine
2. National Institutes of Health. The National Institute of Mental Health highlights new research supporting ketamine as a rapid-acting depression treatment, offering hope for patients who haven’t responded to standard care. https://www.nimh.nih.gov/news/science-updates/2024/new-hope-for-rapid-acting-depression-treatment
3. American Journal of Psychiatry. Research shows that both single and repeated ketamine infusions can treat treatment-resistant depression, with maintenance infusions extending the duration of benefit. https://psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070834
4. National Institutes of Health. Research supports the integration of psychotherapy with ketamine treatment, showing that the combination may produce more durable and meaningful outcomes than ketamine alone. https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/

Reviewed by Dr. Sara Herman

The post What to Expect During Ketamine Therapy: A Complete Session Walkthrough appeared first on Soft Reboot Wellness.

What Depression Does to Brain Chemistry

The most familiar story about depression involves serotonin: not enough of it, and mood suffers. That account is not wrong, but it is incomplete. Depression disrupts multiple neurotransmitter systems simultaneously, and the downstream consequences extend well beyond how a person feels on a given day.

Among the most significant changes is what happens to BDNF (brain-derived neurotrophic factor), a protein that supports the growth, survival, and maintenance of neurons (brain cells). In people with depression, BDNF levels are often markedly reduced. This matters because BDNF is essentially the brain’s maintenance crew: without adequate levels, neurons in mood-regulating regions begin to atrophy, synaptic connections weaken, and the brain’s capacity to adapt and recover is compromised. Research has shown that ketamine directly increases BDNF, which may explain part of its rapid antidepressant effect (National Institutes of Health).

The hippocampus, a brain region central to memory formation and emotional regulation, is particularly vulnerable to these changes. Studies show that prolonged depression can actually reduce hippocampal volume, contributing to the memory difficulties and cognitive fog that many patients describe alongside low mood (National Institutes of Health). For Silicon Valley professionals who rely on sharp thinking, this aspect of depression’s neurological footprint is often deeply disruptive.

The Glutamate Gap That SSRIs Don’t Fill

First-line antidepressants, SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), work by increasing the availability of serotonin and norepinephrine at synapses. They help a significant portion of people with depression, and we respect their role in treatment (National Institutes of Health). But they operate on a specific subset of the brain’s chemistry, and for patients whose depression involves substantial glutamate system dysregulation, serotonin-targeted treatment may simply not be addressing the right problem.

Glutamate is the brain’s primary excitatory neurotransmitter, it drives the vast majority of signaling between neurons. When the glutamate system is dysregulated, as appears to be the case in many forms of treatment-resistant depression, the brain loses some of its capacity for neuroplasticity: the ability to form new connections, reorganize existing pathways, and recover from damage. This is the gap that has made a growing number of clinicians and patients look past the standard antidepressant toolkit.

At Soft Reboot Wellness, Dr. Sara Herman, a Harvard-trained anesthesiologist who has guided more than 10,000 patients through anesthesia and ketamine therapy, built our practice around this understanding. The patients who find their way to us have frequently tried multiple antidepressants, often for years, and still feel stuck. Their experience is not a failure of willpower; it reflects a biological reality about which neurotransmitter systems their depression is actually engaging.

How Neuroplasticity Becomes the Target

Neuroplasticity, the brain’s ability to reorganize itself by forming new neural connections, is not a static trait. It can be increased or decreased by environment, stress, illness, and treatment. Chronic depression is one of the more reliable ways to suppress it; effective treatment for depression is one of the more reliable ways to restore it.

Research shows that ketamine promotes neuroplasticity in ways that standard antidepressants do not, and does so rapidly, changes that SSRIs typically require weeks to approximate can appear within hours of a ketamine infusion (National Institutes of Health). This speed is clinically meaningful. For someone in the grip of severe depression, a week matters. For someone who has been waiting for months across multiple medication trials, the prospect of a different timeline is significant.

The mechanism behind this rapid effect runs through NMDA receptor blockade and the subsequent release of glutamate in a pattern that activates neuroplasticity pathways. In plain terms: ketamine briefly disrupts the brain’s usual signaling, and when that disruption resolves, the brain rebuilds connections in a healthier pattern. It is a reset, not a permanent fix achieved in a single session, but a meaningful opening that, with appropriate integration support, can be built upon.

What This Means for Treatment-Resistant Depression

For patients who have not responded to two or more antidepressant trials, the neuroscience strongly suggests the problem is not that they haven’t found the right serotonin medication. The problem may be that the serotonin system is not the primary driver of their depression at all.

Our IV ketamine infusions at Soft Reboot Wellness target the glutamate system directly, bypassing the serotonin pathway entirely and addressing the neuroplasticity deficit that standard medications leave untouched. A standard induction series involves four to six infusions over four to six weeks, with the protocol personalized to your response. We use the Osmind EHR platform for mood tracking throughout, so progress is documented rather than impressionistic. For patients who want to use the neuroplastic window opened by ketamine for deeper psychological work, our ketamine-assisted psychotherapy (KAP) program adds a preparation session and integration coaching.

We also work closely with patients’ existing treatment teams. If you have a psychiatrist or therapist, we coordinate with them, with your permission, because the neurobiological changes ketamine may produce are best consolidated through ongoing therapeutic work. Results vary by individual, and we encourage you to discuss whether ketamine therapy is appropriate for your specific history with your current healthcare provider.

Addressing the Fear of Starting Something New

One barrier we hear from patients often is not skepticism about the science. It is the exhaustion that comes from having tried things before and having them not work. After multiple medication trials, hope becomes a liability that feels too expensive to extend again.

We understand that. Dr. Herman and our team approach every new patient with the awareness that they are arriving with a history, not just a diagnosis. The initial intake process is designed to give us a thorough picture of what you have tried, for how long, and how you responded, so our recommendations are grounded in your actual trajectory, not a generic protocol. Treatment is not appropriate for everyone, and we will tell you honestly if we do not think we are the right fit.

The cost of ketamine therapy is a real consideration. IV ketamine for mental health is an off-label treatment, and insurance coverage is not standard. We recommend contacting our team at hello@softrebootwellness.com or 650-419-3330 to discuss the financial realities before your consultation, so there are no surprises on either side of the conversation.

Frequently Asked Questions

Can depression actually shrink your brain? Research suggests prolonged depression is associated with reduced volume in the hippocampus and other mood-regulating regions, likely due to the neurotoxic effects of chronic stress hormones and reduced BDNF levels (National Institutes of Health). These changes are not necessarily permanent, effective treatment, including approaches that promote neuroplasticity, may help restore some of this lost volume over time. Results vary by individual.

Why do antidepressants take so long to work if depression is a brain chemistry problem? SSRIs and SNRIs modulate neurotransmitter availability gradually, and the downstream structural changes that correspond with symptom improvement, including neuroplasticity shifts, take weeks to develop. The delay is a function of how those medications work at the synaptic level. Ketamine’s mechanism differs: it triggers a rapid glutamate release and neuroplasticity cascade that can produce antidepressant effects much faster, often within hours of infusion (National Institutes of Health).

Does everyone with depression have glutamate dysregulation? Not necessarily. Depression is not a single condition with a single mechanism. Glutamate dysregulation appears to be more prominent in treatment-resistant presentations, people who have not responded to serotonin-targeting medications. This is part of why we conduct a thorough review of your treatment history before recommending IV ketamine therapy.

How does cognitive fog from depression relate to brain changes? The memory and concentration difficulties many people experience with depression are tied to the same neurobiological changes that affect mood, particularly reduced hippocampal function and BDNF depletion. Effective treatment that addresses these underlying mechanisms may improve cognitive symptoms alongside mood, though results vary significantly between individuals.

Key Takeaways

• Depression produces measurable changes in brain chemistry and structure, including reduced BDNF, hippocampal atrophy, and glutamate system dysregulation. It is not simply a mood state.
• Standard antidepressants target the serotonin and norepinephrine systems; they may not adequately address glutamate dysregulation, which is common in treatment-resistant presentations.
• Neuroplasticity, the brain’s capacity to form new connections, is suppressed by chronic depression and can be rapidly restored by ketamine infusion.
• Our IV ketamine therapy at Soft Reboot Wellness in Menlo Park directly targets the glutamate-neuroplasticity pathway that many patients have not yet addressed.
• Results vary by individual; treatment candidacy is determined through a thorough medical and psychiatric review.

If your depression has not responded the way you hoped to standard treatment, the neuroscience suggests you are not broken, you may simply need treatment that works on a different system. We are glad to talk through whether that is something we can help with. Call us at 650-419-3330 or email hello@softrebootwellness.com to start the conversation.

References

1. Mayo Clinic. Symptoms and causes of major depressive disorder. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
2. National Institutes of Health. Ketamine promotes neuroplasticity, the brain’s ability to form new neural connections, which may explain its rapid and sustained antidepressant effects. https://pmc.ncbi.nlm.nih.gov/articles/PMC8190578/
3. National Institutes of Health. Ketamine has been shown to increase brain-derived neurotrophic factor (BDNF), a protein essential for neuron growth and long-term mood regulation. https://pubmed.ncbi.nlm.nih.gov/39684808/
4. National Institutes of Health. Research documents the efficacy and limitations of SSRIs as a first-line treatment for depression and anxiety. https://pmc.ncbi.nlm.nih.gov/articles/PMC8395812/
5. National Institutes of Health. Research shows depression can impair memory and cognitive function, which may be improved with effective treatment. https://pmc.ncbi.nlm.nih.gov/articles/PMC5835184/

Medical Disclaimer: The information in this blog is for educational purposes only and does not constitute medical advice. Treatment for depression, including IV ketamine therapy, 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.

Reviewed by Dr. Sara Herman

The post How Depression Changes Your Brain: The Neuroscience Explained appeared first on Soft Reboot Wellness.

The Moment of Infusion

When ketamine enters the bloodstream via IV, the delivery method used at Soft Reboot Wellness, it reaches peak plasma concentration quickly and crosses the blood-brain barrier efficiently. Within minutes of infusion onset, the drug begins binding to NMDA receptors: N-methyl-D-aspartate receptors that sit on the surface of neurons and play a central role in regulating how those neurons communicate.

NMDA receptors are part of the glutamate system (the brain’s primary excitatory neurotransmitter network), responsible for the majority of signaling between neurons (National Institutes of Health). Under normal circumstances, NMDA receptors open in response to glutamate binding and allow ions to flow across the neuron membrane, initiating electrical signals. Ketamine enters the receptor channel and blocks this flow. The receptor is occupied but not activated.

This blockade sounds suppressive, and in one narrow sense it is. But the downstream consequence is counterintuitive: blocking NMDA receptors transiently causes a compensatory surge of glutamate release in surrounding circuits. That surplus glutamate then activates a different receptor type, AMPA receptors, which triggers a cascade of intracellular signaling that ultimately promotes synaptic plasticity, or the strengthening and reorganization of neural connections (National Institutes of Health).

The Neuroplasticity Cascade

The AMPA activation that follows NMDA blockade sets off a series of events inside the neuron. Among the most important is the production and release of BDNF (brain-derived neurotrophic factor), a protein that supports the growth, survival, and formation of new synaptic connections (National Institutes of Health). BDNF is often called the brain’s fertilizer, and the analogy holds: it is what allows neurons to grow new dendritic spines: the tiny projections through which neurons receive signals from neighboring cells.

In a brain affected by depression or PTSD, this infrastructure has often been degraded. Chronic stress hormones suppress BDNF, weaken synaptic connections, and reduce the density of dendritic spines in regions like the prefrontal cortex and hippocampus, areas central to mood regulation, decision-making, and emotional context. Ketamine’s BDNF-stimulating effect begins reversing this within hours of infusion, which is the most credible explanation for why antidepressant effects appear so quickly compared to medications that require weeks to achieve similar downstream results.

Research published in Nature also points to a secondary mechanism: ketamine appears to interact with the brain’s opioid system in ways that may contribute independently to its antidepressant action (Nature). This suggests ketamine is not a single-pathway drug, it works through at least two distinct systems simultaneously, which may explain both its breadth of effect across different conditions and the variation in how individual patients respond.

Why IV Delivery Matters

Ketamine can be administered in several ways, intravenously, intramuscularly, as an intranasal spray, or as oral lozenges. Each route produces a different pharmacokinetic profile: different rates of absorption, different peak concentrations, different durations of effect.

IV delivery, the method used at Soft Reboot Wellness, produces the most precise and controllable pharmacological profile. The dose enters the bloodstream directly, with no absorption variability from the gut or nasal mucosa. Peak plasma levels are reached quickly and predictably. The physician can adjust the infusion rate in real time based on the patient’s response. For patients whose treatment history involves partial or inconsistent responses to other medication forms, this precision matters.

Dr. Sara Herman, our Harvard-trained anesthesiologist with more than two decades of experience administering IV medications, personally provides and monitors all infusion sessions. The clinical environment at our Menlo Park clinic includes continuous vital sign monitoring and immediate access to intervention if needed. The dose used in mental health treatment is a fraction of what is administered for surgical anesthesia, sub-anesthetic dosing is well-tolerated and carries a well-established safety profile when administered by qualified clinicians in an appropriately equipped setting.

The Hours and Days After Infusion

The acute pharmacological effects of a ketamine infusion, the altered perception, the dissociative quality, resolve fully within one to two hours of infusion completion. What persists is the neuroplastic change the infusion has initiated. BDNF levels remain elevated. New synaptic connections are forming. The brain’s default circuitry, including the default mode network, which governs self-referential thinking and is often overactive in depression, is temporarily reorganized.

The 48 to 72 hours following infusion represent what many clinicians describe as an integration window: the period during which the brain is most receptive to the consolidation of new patterns. This is why the timing of integration work matters. At Soft Reboot Wellness, our KAP program is structured specifically around this window, the preparation session happens before infusion, and the integration coaching sessions are timed to the period when the brain is most able to use the new neural architecture the infusion has created.

Research confirms that a series of infusions produces cumulative neuroplastic benefit, repeated sessions extend and deepen the changes initiated by the first (National Institutes of Health). Our standard induction protocol involves four to six IV infusions over four to six weeks, with the specific protocol calibrated to your clinical response and informed by mood data tracked through the Osmind platform throughout your treatment.

What the Pharmacology Means for Candidacy

The same mechanism that makes ketamine effective for many patients also creates genuine contraindications for others. Because ketamine increases blood pressure transiently during infusion, patients with uncontrolled hypertension or certain cardiovascular conditions require additional clinical judgment before proceeding. Patients with a history of psychosis or certain personality disorders may not be appropriate candidates, as the dissociative properties of ketamine carry different risk profiles in those populations. Active substance use disorders also require careful evaluation.

This is why the consultation and review process at Soft Reboot Wellness is thorough, not perfunctory. We review your full medical and psychiatric history, your current medications, and your prior treatment responses before making any recommendation. Results vary by individual, and we encourage you to discuss all options with your existing healthcare provider before deciding whether IV ketamine therapy is appropriate for you.

IV ketamine for mental health is an off-label treatment, and insurance coverage is not standard. We recommend contacting our team at 650-419-3330 or hello@softrebootwellness.com before your consultation so that cost is a clear part of your decision-making rather than a surprise afterward.

Frequently Asked Questions

Why does IV ketamine work faster than oral or nasal forms? IV delivery bypasses the absorption variability that affects oral and intranasal routes. The medication enters the bloodstream directly, reaching predictable peak plasma concentrations quickly and allowing the administering physician to adjust the dose in real time. This precision produces a more reliable pharmacological effect, which is one reason IV remains the method with the strongest clinical evidence base for psychiatric indications.

What is the difference between the acute effects of ketamine and the lasting antidepressant effects? The acute effects, altered perception, dissociation, dreamlike quality, are a product of active NMDA receptor blockade during the infusion and resolve within one to two hours. The lasting antidepressant effects are a product of the downstream neuroplastic cascade: BDNF elevation, synaptic connection formation, and dendritic spine growth that continue developing in the hours and days after the infusion ends. The experience and the therapeutic mechanism are related but distinct.

Does ketamine lose effectiveness over time with repeated infusions? Some patients do find that the response to maintenance infusions shifts over time, either diminishing or requiring different spacing. This is not universal, and the clinical picture varies considerably between individuals. We monitor response throughout treatment using mood tracking data and adjust the protocol accordingly. Some patients require only occasional boosters; others benefit from a more regular maintenance schedule.

How does the opioid system interaction affect the risk of dependence? The opioid system interaction identified in recent research does not mean ketamine functions as an opioid or carries comparable dependence risk. The interaction appears to occur at different receptor subtypes and at a different scale than classical opioid medications. Ketamine does carry its own potential for misuse at high doses outside clinical settings, which is one reason administration in a supervised clinical environment with appropriate screening is medically required.

Key Takeaways

• IV ketamine blocks NMDA receptors, triggering a compensatory glutamate surge that activates AMPA receptors and initiates a neuroplasticity cascade, the core mechanism of its antidepressant effect.
• BDNF elevation following infusion supports new synaptic connection formation in brain regions degraded by chronic depression or trauma.
• Emerging research suggests ketamine also interacts with the opioid system as a secondary pathway, pointing to a multi-mechanism pharmacological profile.
• IV delivery produces the most precise and controllable pharmacokinetic profile; Dr. Herman personally monitors all infusion sessions at our Menlo Park clinic.
• The 48 to 72 hours following infusion are the prime integration window; our KAP program is timed around this period to maximize the value of the neuroplastic changes ketamine initiates.

Knowing what ketamine does in the body, not just that it works, but how and why, puts you in a better position to decide whether it belongs in your treatment plan. We are glad to walk through that conversation in depth. Call us at 650-419-3330 or email hello@softrebootwellness.com to start the conversation.

References

1. National Institutes of Health. The glutamate neurotransmitter system is the brain’s primary excitatory system and a key pathway through which ketamine produces its therapeutic effects. https://www.ncbi.nlm.nih.gov/books/NBK62187/
2. National Institutes of Health. Ketamine promotes neuroplasticity, the brain’s ability to form new neural connections, which may explain its rapid and sustained antidepressant effects. https://pmc.ncbi.nlm.nih.gov/articles/PMC8190578/
3. National Institutes of Health. Ketamine has been shown to increase brain-derived neurotrophic factor (BDNF), a protein essential for neuron growth and long-term mood regulation. https://pubmed.ncbi.nlm.nih.gov/39684808/
4. Nature. Research suggests ketamine may also produce antidepressant effects by interacting with the brain’s opioid system, pointing to multiple mechanisms of action. https://www.nature.com/articles/s41591-025-03800-w
5. National Institutes of Health. Multiple ketamine infusion sessions have been shown to produce cumulative antidepressant benefits and extend remission periods in patients with depression. https://pmc.ncbi.nlm.nih.gov/articles/PMC6236511/

Medical Disclaimer: The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy should only be pursued under the supervision of a licensed medical provider familiar with your full medical and psychiatric history. Individual results vary. Off-label treatments like IV ketamine for mental health conditions carry risks that should be discussed thoroughly with a qualified provider before beginning. 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.

Reviewed by Dr. Sara Herman

The post How Ketamine Works in the Body: From Infusion to Brain Changes appeared first on Soft Reboot Wellness.

How Ketamine Differs From Classical Psychedelics

Most people think of psychedelics in terms of substances like psilocybin or LSD, which work primarily by activating serotonin 2A receptors, a specific docking site on brain cells involved in perception and mood. Ketamine does something different. Its primary mechanism involves blocking NMDA receptors (N-methyl-D-aspartate receptors), which are part of the glutamate system, the brain’s main excitatory neurotransmitter network (National Institutes of Health). Rather than flooding the serotonin system, ketamine modulates glutamate transmission, triggering a cascade of downstream effects that researchers now understand to include rapid antidepressant action and new neural connection formation.

That distinction is not merely academic. It explains why ketamine can produce perceptual changes at therapeutic doses without fitting neatly into the classical psychedelic category. Some researchers classify it as a “dissociative,” others as a “psychedelic-adjacent” compound, and a growing number argue it belongs in its own class entirely. At Soft Reboot Wellness, Dr. Sara Herman and Dr. Natasha work with patients who have often spent years trying serotonin-targeting medications without adequate relief, patients for whom the glutamate pathway may be the missing piece.

The Psychedelic Experience Question

Even if the receptor mechanism differs, ketamine at therapeutic doses can produce experiences that overlap with what people describe in psychedelic-assisted therapy: altered perception of time, a sense of the mind loosening its grip on habitual thoughts, and occasionally vivid inner imagery. This is not a side effect to be managed. It is, in many respects, part of why the treatment works.

Research supports the integration of psychotherapy with ketamine, showing the combination may produce more durable and meaningful outcomes than ketamine alone (National Institutes of Health). This is precisely why our ketamine-assisted psychotherapy (KAP) program at Soft Reboot Wellness pairs in-office infusion sessions with preparation and integration coaching. Dr. Herman holds an Advanced Certificate in Psilocybin-Assisted Therapy from the Integrative Psychiatry Institute and has completed training in Internal Family Systems (IFS) combined with ketamine-assisted psychotherapy, credentials that reflect a genuine commitment to psychedelic medicine as a therapeutic discipline, not just a pharmacological one.

Why the Classification Matters for Patients

Patients searching “is ketamine a psychedelic” are often asking a more personal question underneath that one: will this feel strange, and is that strangeness safe? Both are fair concerns, and we take them seriously.

The perceptual effects of IV ketamine at therapeutic doses are time-limited, occur within a supervised clinical setting, and resolve completely by the time patients leave. Dr. Herman personally provides and monitors all treatment sessions. The dose used in mental health treatment is a fraction of what is used in surgical anesthesia, and the clinical environment at our Menlo Park clinic is designed for comfort and safety throughout. Vital signs are monitored continuously, and patients are never left alone during their infusion.

What the altered state offers, when approached with intention, is a window. Research on how psychedelic-type treatments promote healing suggests these compounds create conditions for neuroplasticity, the brain’s capacity to form new neural connections, by temporarily quieting entrenched patterns of thought and self-criticism (National Institutes of Health). For patients with treatment-resistant depression, anxiety, or PTSD, that window can be genuinely significant.

How Soft Reboot’s Approach Reflects the Science

We did not land on our current model by accident. Our practice is built around the understanding that ketamine’s mechanism (glutamate modulation, NMDA receptor blockade, downstream neuroplasticity) offers something that decades of serotonin-focused treatment have not fully delivered for a substantial portion of patients (Johns Hopkins Bloomberg School of Public Health). That is not a criticism of antidepressants; SSRIs help many people. It is an honest acknowledgment that the brain’s chemistry is more complex than any single system, and that the patients who find their way to us have typically already learned that lesson the hard way.

Our IV ketamine infusions follow a personalized induction protocol, typically four to six infusions over four to six weeks, with the specific number and timing calibrated to your clinical response and the input of your existing treatment providers. We use the Osmind EHR platform for mood tracking throughout your treatment so both you and your care team can see your progress objectively. Each infusion is paired with preparation and integration coaching as part of our ketamine-assisted psychotherapy (KAP) program.

Addressing the Cost and Scheduling Reality

Ketamine therapy is a meaningful financial commitment, and we want to be direct about that. IV ketamine for mental health conditions is considered off-label use, meaning it is an established treatment whose mental health applications have not yet received formal FDA approval for specific psychiatric diagnoses, and insurance coverage is inconsistent. We recommend contacting our team directly to discuss what financial options are available to you before your consultation.

The initial consultation at Soft Reboot Wellness begins by calling or emailing us directly. We send you an intake packet, Dr. Herman reviews it, and then determines whether to schedule a consultation. If you have an existing psychiatrist, therapist, or prescriber, we actively coordinate with them, with your consent, because we believe integrative care produces better outcomes than any single provider working in isolation. Results vary by individual, and we encourage you to discuss all options with your healthcare provider before deciding whether ketamine therapy is right for you.

Frequently Asked Questions

If ketamine isn’t technically a psychedelic, why does it sometimes produce visual or perceptual effects? Ketamine’s dissociative properties at therapeutic doses can produce altered sensory experiences, mild perceptual shifts, a floating or dreamlike quality, or vivid imagery, even though its mechanism differs from classical psychedelics. These effects occur because ketamine affects multiple neurotransmitter systems, not just glutamate. They are temporary, resolve fully within hours, and occur within a monitored clinical environment at our Menlo Park clinic.

Is ketamine therapy the same as recreational ketamine use? No. The dose, delivery method, clinical setting, and intent are entirely different. Therapeutic ketamine infusions are administered intravenously at sub-anesthetic doses by a licensed physician in a clinical environment with continuous monitoring. Recreational use involves very different doses, routes, and contexts. Our team screens all candidates medically and psychiatrically before treatment to ensure it is appropriate for each individual.

Does Soft Reboot Wellness offer psilocybin therapy? We do not currently offer psilocybin therapy as a clinical service. Dr. Herman holds an Advanced Certificate in Psilocybin-Assisted Therapy and stays current with the evolving research in this area, but our active treatment offerings are IV ketamine infusions, ketamine-assisted psychotherapy, stellate ganglion block (SGB), and NAD+ infusions.

How does understanding ketamine’s mechanism help me prepare for my session? Knowing that ketamine works through the glutamate system, promoting neuroplasticity and temporarily quieting rigid thought patterns, can help you approach your session with openness rather than anxiety. Many patients find it useful to set a simple intention before their infusion, something they want to reflect on or release, and to plan for rest and reflection afterward. Our integration coaching component is designed specifically to help you make the most of this window.

Can ketamine therapy be combined with my existing antidepressants or therapy? In many cases, yes, and we actively encourage coordination with your existing treatment team. The specifics depend on your medications and history, which we review during your consultation. We do not ask patients to discontinue existing medications without a conversation involving you and your other providers.

Key Takeaways

• Ketamine is not a classical psychedelic, it works primarily through NMDA receptor blockade in the glutamate system, not through serotonin 2A receptor activation.
• The perceptual effects some patients experience during treatment are a product of this multi-system mechanism and are temporary, monitored, and managed within a clinical setting.
• Research supports combining psychotherapy with ketamine to produce more durable outcomes. This is the foundation of our KAP program at Soft Reboot Wellness.
• IV ketamine for mental health is an off-label use, and insurance coverage is not standard; financial details are best discussed directly with our team.
• Results vary by individual, and candidacy is determined through a thorough medical and psychiatric review before any treatment begins.

Whether you think of ketamine as a psychedelic, a dissociative, or simply a medication that works differently than anything you have tried before, what matters most is whether it might help you. At Soft Reboot Wellness, we are here to answer that question honestly, starting with a conversation. Reach us at 650-419-3330 or email hello@softrebootwellness.com to get started.

References

1. National Institutes of Health. Ketamine works by blocking NMDA receptors in the glutamate system, producing rapid antidepressant effects through a mechanism distinct from traditional antidepressants. https://pmc.ncbi.nlm.nih.gov/articles/PMC5148235/
2. Johns Hopkins Bloomberg School of Public Health. Overview of ketamine’s history, from its origins as an anesthetic to its current use as a fast-acting treatment for depression. https://publichealth.jhu.edu/2024/what-to-know-about-ketamine
3. National Institutes of Health. Psychedelic substances promote neuroplasticity, which may underlie their therapeutic effects on mood, trauma, and addiction. https://pmc.ncbi.nlm.nih.gov/articles/PMC9665925/
4. National Institutes of Health. Research supports the integration of psychotherapy with ketamine treatment, showing that the combination may produce more durable and meaningful outcomes than ketamine alone. https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/

Medical Disclaimer: The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy should only be pursued under the supervision of a licensed medical provider familiar with your full medical and psychiatric history. Individual results vary. Off-label treatments like IV ketamine for mental health conditions carry risks that should be discussed thoroughly with a qualified provider before beginning. 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.

Reviewed by Dr. Sara Herman

The post Is Ketamine a Psychedelic? Understanding the Science Behind Ketamine Therapy appeared first on Soft Reboot Wellness.

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.

Reviewed by Dr. Sara Herman

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