Ketamine-assisted therapy

What it is

A legal anesthetic used off-label in clinics (IV, IM, oral) plus esketamine (Spravato). Best when paired with preparation and integration, not drips alone.

Evidence

Helps some depression. The large veteran study people skip: Abdallah and colleagues, multicenter VA/DoD trial (~158 veterans and service members). Twice-weekly IV ketamine for four weeks did not beat control on PTSD symptoms in the planned analysis. Smaller open-label work pairing ketamine with PE is not a replacement for that trial. Spravato is a depression indication.

Access for veterans

Widest U.S. PAT-style path. Some VA coverage for Spravato in treatment-resistant depression, not as a PTSD indication. Grants exist via veteran PAT nonprofits.

Cautions

Blood pressure, dissociation, bladder risk with heavy use, and chasing infusions without therapy.

Sources

• Abdallah CG et al. Dose-related effects of ketamine for antidepressant-resistant PTSD — VA/DoD multicenter trial, 2022.
• VA National Center for PTSD — psychedelic-assisted therapy explainer (professional).

Evidence reviewed September 2026.

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