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.

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

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

Why What You Bring to the Session Matters

Ketamine works in part by promoting neuroplasticity, temporarily loosening the brain’s entrenched patterns and creating a window of increased receptivity to change (National Institutes of Health). This window is not passive. What you choose to focus on, reflect on, or remain open to during and after the session can shape what the brain does with the new neural architecture the infusion creates.

Research on how psychedelic-type treatments promote healing points to the role of emotional processing and intention in determining outcomes (National Institutes of Health). Patients who approach their sessions with a defined intention, something specific they want to examine, release, or understand, tend to report more meaningful experiences than those who treat the infusion as something to simply endure or wait out. This is one of the central premises of our ketamine-assisted psychotherapy (KAP) program, which is built around the preparation and integration work that surrounds each infusion, not just the pharmacology itself.

None of this means you need to have a plan for every moment. The session should not feel like a performance or an assignment. The goal is to arrive with orientation, a direction, not a script.

Setting an Intention Before You Arrive

In the days before your session, we encourage patients to spend some quiet time identifying what they most want to bring into the experience. An intention is not a goal in the productivity sense. It is not “fix my depression” or “resolve my trauma.” It is simpler and more personal than that.

Some examples of intentions patients bring to sessions at Soft Reboot Wellness: an openness to understanding where a particular emotion is coming from; a willingness to observe a chronic thought pattern without being inside it; a desire to reconnect with something that has felt inaccessible, joy, creativity, a sense of self that existed before the depression took hold. These are starting points, not destinations.

The Internal Family Systems (IFS) framework that Dr. Sara Herman has trained in offers a useful lens here. IFS treats the mind as a system of distinct internal parts, some that protect, some that carry pain, some that have been exiled. A session intention framed in IFS terms might sound like: “I want to meet the part of me that keeps me working beyond exhaustion and understand what it’s afraid of.” This is more actionable than “I want to feel better” and more honest than pretending the session is simply a medication administration.

Mindfulness practice in the days before your infusion can also be helpful, not because the session requires you to meditate, but because the skills of present-moment awareness and non-judgmental observation are genuinely useful when unusual internal experiences arise (Mindful.org). If you have an existing mindfulness or meditation practice, lean on it before your session. If you do not, even brief daily attention to breath and body in the days prior can create a more grounded starting point. Our post on five ways to turn inward offers practical techniques you can begin before your first session.

During the Infusion: Openness Over Control

Once the infusion begins, the most useful orientation is one of openness rather than control. The altered state ketamine produces, the quieting of ordinary thought, the perceptual shifts, the loosening of the usual mental categories, is working in your favor. Resisting it, or trying to steer the experience toward a predetermined outcome, tends to work against the therapeutic process.

If difficult emotions or memories arise, the most effective response is generally to observe them rather than either suppress them or intensify them. The IFS model is helpful here too: rather than identifying with a difficult internal state (“I am overwhelmed”), you can relate to it as information, a part of you that is asking to be seen. This perceptual shift is subtle but meaningful, and it is one reason Dr. Herman’s IFS training is built into the KAP program rather than treated as supplementary.

Some patients find it helpful to use music during their session, it provides structure to the experience and can serve as an anchor when the altered state becomes intense. Others prefer silence or nature sounds. We are happy to discuss music selection in your preparation session, because the choice matters more than most patients expect. Our post on music as medicine explores how intentional sound selection can deepen the therapeutic experience.

Above all: you do not need to figure anything out during the infusion. The neuroplastic work is happening whether or not you consciously direct it. Your role is less to think and more to receive, to stay present with whatever arises without forcing it toward resolution.

What to Do With What Arises

The 48 to 72 hours following a session are what researchers call the integration window: the period during which the neuroplastic changes initiated by the infusion are most active, and the brain is most open to consolidating new patterns and associations (National Institutes of Health). What you do in this window is not incidental. It is part of the treatment.

Journal. Not to produce polished writing, but to capture what arose, images, emotional residue, insights, questions. The specific language matters less than the act of externalizing what was internal. Patients frequently find that experiences that felt opaque during the session become clearer when written down in the hours afterward.

Move gently. Light walking, stretching, time outdoors, physical movement supports the integration process in ways that are not fully understood but consistently reported by patients. Avoid intense exercise, alcohol, and stimulants during this window.

Bring the material to your next therapy session if you have an outside therapist. Many patients find that a ketamine series deepens their ongoing therapeutic work in ways they did not anticipate, the loosening of habitual defenses that the infusion produces often makes previously defended emotional territory more accessible.

Integration coaching sessions are timed specifically around this 48-to-72-hour window. Our certified psychedelic integration coach, trained by Being True to You, works with you to make sense of what the session opened and how to carry it forward. You can explore additional integration ideas on our integration inspirations page.

Preparing for a Full Series, Not Just One Session

It is worth framing the experience correctly from the start: a single ketamine infusion is the beginning of a series, not a standalone event. Research shows that repeated ketamine sessions produce cumulative antidepressant benefits and extend remission periods, each infusion builds on the neuroplastic foundation laid by the previous one (National Institutes of Health). Approaching the series as a sustained commitment, rather than waiting for one session to produce a definitive result, tends to produce better outcomes.

This means the intention and integration work is not a one-time exercise. Before each session in your series, we encourage you to revisit your intention, it may evolve across sessions, and that evolution is informative. After each session, the journaling and integration practices apply again. Mood data tracked through the Osmind app across the full series gives you and our clinical team an objective record of your trajectory.

Results vary by individual. Not every patient finds the intention-setting or integration work immediately natural, and that is normal. Our care team is here to support this process throughout, not just during the infusions themselves. For a complete picture of what each session involves day by day, see our full post on IV ketamine therapy at Soft Reboot Wellness.

Addressing the Practical Before and After

On the day of your infusion, we ask that you avoid alcohol for at least 24 hours prior and arrive having eaten lightly two to four hours beforehand. Wear comfortable clothing. Arrange your driver in advance, you cannot drive yourself home afterward, and this is a clinical requirement without exceptions.

Plan to protect the afternoon and evening of your infusion day. The most common post-session experience is feeling relaxed and emotionally open, but scheduling demanding commitments for the same evening works against the integration process. The following day, most patients return to their normal professional routines without issue.

IV ketamine for mental health is an off-label treatment, and insurance coverage is not standard. The cost commitment is real, and we encourage you to discuss it with our team at 650-419-3330 or reach us through our contact page at hello@softrebootwellness.com before your consultation so it is part of your planning rather than a surprise. We also encourage you to discuss all treatment options with your existing healthcare providers before beginning. Results vary by individual.

Frequently Asked Questions

What if I don’t know what my intention should be before a session? That is completely normal, especially before a first session. Our preparation session is specifically designed to help you identify a workable intention. It is a facilitated conversation, not a test. Arriving with openness and genuine curiosity is itself a strong starting point.

Is there anything I should avoid thinking about during a session? Rather than thinking in terms of avoidance, we suggest thinking in terms of orientation. Trying to suppress specific content tends to amplify it. A more effective approach is to hold a broader intention, openness, curiosity, compassion toward whatever arises, and let the session unfold from there. If something difficult comes up, the most useful response is to observe it rather than fight it or pursue it.

How do I know if my integration practice between sessions is working? Progress in integration is rarely linear or dramatic. Signs that it is working include: finding habitual thought patterns slightly more available for observation, noticing emotional states with a little more space between stimulus and response, or simply feeling incrementally more present in daily life. The Osmind mood data gives you an objective reference point alongside these more qualitative signals.

What role does my outside therapist play during the ketamine series? We encourage patients with existing therapists to bring the material from their ketamine sessions directly into their ongoing therapeutic work. The neuroplastic window opened by ketamine often makes previously defended emotional territory more accessible in therapy, many patients describe a ketamine series as accelerating months of therapeutic work into weeks. We coordinate with outside therapists with your consent throughout treatment.

Key Takeaways

• What you bring to a ketamine session, intention, openness, willingness to observe what arises, shapes the therapeutic outcome alongside the pharmacology.
• Setting a simple, honest intention before each session gives the neuroplastic window opened by ketamine a direction to work with.
• During the infusion, openness over control is the most effective orientation; resistance and forced steering tend to work against the therapeutic process.
• The 48 to 72 hours following infusion are the integration window, journaling, gentle movement, and reflection during this period are part of the treatment, not afterthoughts.
• Our KAP program at Soft Reboot Wellness is structured specifically around preparation and integration as clinical steps, not optional add-ons.

Preparation is how you meet ketamine halfway. If you are ready to start thinking about what this process might look like for you, we are glad to be part of that conversation. 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. Research explores the neurological mechanisms behind psychedelic-assisted therapy, including how these treatments promote emotional processing and neuroplasticity. https://pmc.ncbi.nlm.nih.gov/articles/PMC10786285/
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. 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/
4. 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/
5. Mindful.org. An accessible overview of mindfulness practices and their documented benefits for mental health and stress management. https://www.mindful.org/what-is-mindfulness/

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 to Think About During Ketamine Therapy: Preparing for Your Session appeared first on Soft Reboot Wellness.