Use the Benefit You Have

A number of VA medical centers offer esketamine, and some provide intravenous ketamine through mental health or anesthesiology services. Availability varies considerably by facility, and it is not always offered proactively, so it usually has to be asked about directly. If you can get this covered, the cost difference against private-pay is substantial and there is no clinical reason to prefer us.

• Ask your VA mental health provider directly about ketamine and esketamine
• Availability differs by facility and is often not raised unprompted
• Community Care referral may be an option where the facility does not offer it
• Cost difference against private-pay is large and worth the phone call
• We will say this at the consultation too, not only on the website

Why the PTSD Evidence Matters Here

PTSD is one of the few indications where ketamine was studied in the condition itself rather than borrowed from depression trials. Feder and colleagues ran randomized trials in patients carrying a PTSD diagnosis, against midazolam as an active control rather than saline, and found significant symptom reduction. For a veteran population where PTSD and depression frequently occur together, that is a stronger footing than most of what gets marketed.

• Randomized trials conducted in PTSD populations with PTSD endpoints
• Midazolam control is a more demanding comparison than placebo
• Repeated dosing studied specifically rather than inferred
• Co-occurring depression tends to respond in the same course
• Symptom reduction is not memory processing; trauma therapy still matters

What Ketamine Does Not Replace

The treatments with the best durable outcomes in PTSD are trauma-focused therapies: cognitive processing therapy, prolonged exposure, EMDR. The VA delivers all three and has invested heavily in training clinicians to do so properly, which is a genuine strength of the system. Ketamine reduces symptom load and may make those therapies more tolerable. Used instead of them it tends not to hold.

• CPT, PE and EMDR have the strongest durable outcome evidence
• The VA trains clinicians in these specifically and offers them at scale
• Ketamine opens a window; therapy is what consolidates the change
• Standalone dosing usually requires ongoing maintenance to sustain effect
• We ask what therapy you are engaged in, and the answer changes the plan

Things That Complicate the Picture

Two issues come up often enough in this population to state directly. Alcohol used to manage symptoms is common and is an exclusion when it reaches use-disorder threshold, not because of judgment but because it changes both safety and outcome. Traumatic brain injury history also needs evaluating, since it affects tolerability and is frequently present alongside PTSD.

• Alcohol use disorder is an exclusion and is asked about directly
• TBI history is evaluated individually and can change candidacy
• Benzodiazepines prescribed for the same symptoms may blunt response
• Prazosin for nightmares is generally continued without change
• Active suicidal planning requires a higher level of care than telehealth

If Private-Pay Is the Right Path

For veterans not enrolled, facing long waits, or who prefer care outside the VA system for reasons of their own, this is a reasonable option. It is physician-led, with the same doctor throughout rather than a rotating panel, and booking windows that extend past a standard clinic day.

• No VA or insurance billing; records sit outside those systems
• Video consultation with Dr. Ben Soffer, DO, and a full medication review
• PCL-5 scored before consultation and repeated to track change
• Extended booking windows including 12:30 PM and 5:00 PM appointments
• A sober support person is required for every session