MONTGOMERY — For Sean, a veteran from Rockville, coming home did not mean the battle was over.
After his military service, he says depression and trauma followed him into civilian life.
The wounds were not always visible to the people around him, but they shaped the way he moved through the world and pushed him to keep searching for relief.
What to know about Ketamine Therapy for veterans struggling with PTSD and depression
His story is now part of a growing conversation in Maryland and across the country about ketamine-assisted psychotherapy, a treatment some mental health providers are using for people living with depression, trauma, and other mental health conditions.
Ketamine is an anesthetic medication that can legally be prescribed off-label for certain mental health conditions. In ketamine-assisted psychotherapy, also known as KAP, the medication is paired with therapeutic support before, during and after the experience.
At Prism Wellness, a holistic psychotherapy practice with offices in Baltimore and Frederick, clinicians say that support is central to the treatment model. The practice says clients are screened first, ketamine is medically overseen by a nurse practitioner, and the process includes preparation and integration therapy.
Prism Wellness founder Erin Atkinson, LCSW-C, said the goal is not simply to administer medication, but to help clients process what comes up during the experience.
“So many people are searching for approaches that reach the roots of their suffering, not just the surface,” Atkinson said. “Ketamine-assisted psychotherapy, when held within a strong therapeutic container and practiced responsibly, can open new pathways for healing. Our work is always oriented toward integration and supporting the whole person.”
For Sean, the struggle has centered on depression and trauma. For other veterans, the invisible wounds of service may also include PTSD, anxiety or moral injury. Prism Wellness says veterans are among the groups for whom this work may hold promise, but the practice also stresses that ketamine-assisted psychotherapy is not appropriate for everyone.
The interest comes at a time when mental health needs remain widespread. The National Alliance on Mental Illness says more than 1 in 5 U.S. adults experience mental illness each year.
Research into ketamine for mental health treatment is still developing. A randomized clinical trial published in The American Journal of Psychiatry found repeated IV ketamine infusions reduced symptom severity in people with chronic PTSD, compared with midazolam, a psychoactive placebo. The authors also said “further studies are warranted,” meaning more research is needed.
Current federal guidance is more cautious. The U.S. Department of Veterans Affairs’ National Center for PTSD says the 2023 VA/DoD clinical practice guideline recommends against ketamine as a treatment for PTSD, citing limited evidence and concerns about risks and side effects.
That distinction is important: some research has shown promise, but ketamine is not currently recommended by the VA as a PTSD treatment.
The U.S. Food and Drug Administration has also warned patients and health care providers about compounded ketamine products. The FDA says ketamine is approved as an anesthetic, but “is not FDA approved for the treatment of any psychiatric disorder.”
There is also esketamine, which is related to ketamine but is not the same as the ketamine used in many ketamine-assisted psychotherapy settings.
Esketamine is sold under the brand name Spravato. It is a nasal spray approved by the FDA for adults with treatment-resistant depression. Unlike off-label ketamine treatment, Spravato has specific FDA-approved psychiatric uses and must be administered under medical supervision because of risks including sedation, dissociation and respiratory depression.
Spravato is also available only through a restricted safety program known as a REMS, or Risk Evaluation and Mitigation Strategy, which is designed to help make sure the benefits of the medication outweigh its risks.
At Prism Wellness, leaders say their expansion is happening alongside a broader effort to train clinicians in ethical and responsible psychedelic-informed care. The practice is launching a continuing education program for licensed therapists focused on psychedelic integration, somatic approaches, ethical practice and current research.
“There is real hunger among clinicians for training that is grounded, ethical, and culturally aware,” Atkinson said. “We want to support therapists in developing the skills they need to work with these modalities responsibly and with integrity.”
For Sean, the story is not about a cure-all. It is about a veteran from Rockville living with depression and trauma, and the search for a way forward.
For the public, the conversation is more complicated: ketamine-assisted psychotherapy is being explored by some clinicians, studied by researchers and scrutinized by regulators. It is not appropriate for everyone, and experts say screening, medical oversight and accurate information are essential.
