When treatment
hasn't worked,
we go further.

If you have struggled with depression, anxiety, or PTSD and felt like traditional medications only got you part of the way there, you are not alone.

For many patients — especially those with treatment-resistant depression or chronic trauma — standard approaches such as SSRIs and therapy can help, but they do not always go far enough. That gap is what has led to the rise of interventional treatments like ketamine and Spravato. At the same time, a quieter but equally important shift is happening in how we understand the brain itself.

We are beginning to see these conditions not just as chemical imbalances, but as disorders involving neuroplasticity, inflammation, and even metabolism.

What We Know About Ketamine and Rapid Symptom Relief

Over the past decade, ketamine has moved from an anesthetic medication to one of the most studied rapid-acting treatments in psychiatry. Clinical trials have shown that ketamine can reduce symptoms of depression and PTSD within hours to days, rather than the weeks typically required for traditional antidepressants. This matters, especially for patients who feel stuck or have not responded to multiple medications.

Spravato and Structured, Regulated Treatment

Intranasal esketamine — Spravato — builds on this same mechanism but is delivered within a highly structured, FDA-approved framework under a REMS protocol. For patients and families, that level of oversight matters. It reflects how seriously these treatments are taken in modern psychiatric care.

Why the Conversation Is Expanding

Newer research suggests depression and PTSD also involve chronic inflammation, changes in brain energy use, and dysregulation of stress response systems. A recent publication in Frontiers in Nutrition explored how metabolic dysfunction may play a role in PTSD — highlighting that nutritional and metabolic factors can influence how the brain processes stress and recovers from trauma. This does not mean nutrition replaces treatment. It means the brain does not function in isolation from the rest of the body.

A More Complete Model of Care

Ketamine and Spravato may help reset brain circuits and improve neuroplasticity. Therapy helps patients process and integrate those changes. Nutrition and metabolic health may support the brain's ability to sustain those gains. No single approach does everything — but together, they begin to address the complexity of treatment-resistant conditions in a more realistic and sustainable way.

The goal is not just symptom relief. It is stability, function, and quality of life.

When a patient has failed two or more antidepressants, the clinical picture shifts. The question is no longer whether their medication needs adjusting — it is whether the standard pharmacological approach is the right tool at all. This is the population ketamine and Spravato were built for. And over the past decade, the evidence has moved from promising to conclusive.

What the Numbers Actually Show

In the landmark ELEKT-D trial published in the New England Journal of Medicine (Anand et al., 2023), 55.4% of patients receiving IV ketamine achieved a meaningful treatment response — defined as at least a 50% reduction in depressive symptoms — compared to 41.2% in the ECT group. Remission rates reached 32.3% to 37.9% depending on the measure used. Critically, ketamine achieved this with significantly fewer cognitive side effects than ECT.

A 2023 systematic review and meta-analysis published in eClinicalMedicine, drawing on 49 randomized controlled trials and over 3,200 patients, found that IV racemic ketamine produced remission rates 2.5 to nearly 4 times higher than placebo. Higher-dose regimens showed sustained remission through repeated treatment courses.

For Spravato, the 2025 JAMA Psychiatry trial by Janik et al. demonstrated that esketamine monotherapy significantly outperformed placebo in reducing depressive symptom severity — one of the first trials to examine esketamine as a standalone treatment rather than an adjunct to an oral antidepressant.

Speed Is the Differentiator

Traditional antidepressants require four to six weeks before a meaningful effect is observed — if one occurs at all. Ketamine can produce measurable symptom reduction within 24 to 72 hours of the first infusion. For patients with active suicidal ideation or severe functional impairment, this speed is not a convenience. It is clinically significant and changes the risk calculus entirely.

PTSD: A Compelling and Growing Evidence Base

Beyond depression, ketamine is showing real promise for chronic PTSD. In the first randomized controlled trial of repeated ketamine infusions for chronic PTSD (Feder et al., 2021, American Journal of Psychiatry), 67% of patients in the ketamine group were classified as treatment responders, compared to 20% in the placebo group. Symptom reduction was rapid, clinically meaningful, and statistically significant. This matters especially for veterans, first responders, and survivors of trauma who have exhausted standard treatment options.

Why Two Out of Three?

Across the strongest available trials, roughly two out of every three patients who receive properly administered IV ketamine or Spravato achieve either significant symptom reduction or full remission. That is not a guarantee — individual outcomes vary, maintenance is required, and these treatments are not appropriate for everyone. But for a population that has, by definition, not responded to standard care, a 55–67% meaningful response rate represents a clinical frontier that did not exist in psychiatry a generation ago.

At Parker Neuroscience, these numbers inform everything — the protocols, the monitoring standards, the follow-up care, and the integration support we provide. Evidence-based does not mean one size fits all. It means knowing what the data shows and building a clinical approach around it.

What This Means for You

If you or someone you care about has been through the standard treatment pathway without adequate results, the evidence no longer supports waiting. These are not experimental treatments. They are among the most studied rapid-acting interventions in modern psychiatry, supported by randomized controlled trials published in the New England Journal of Medicine, JAMA Psychiatry, and the American Journal of Psychiatry. The question is not whether these treatments work. The question is whether they are right for you — and that begins with a conversation.

I am an Air Force veteran. My son is currently serving on active duty. When a veteran or first responder walks through my door, I am not approaching their care from a textbook. I understand, at least in part, what it took to get here.

Let me be direct about something first. The problem veterans and first responders face when it comes to mental health care is not one thing. It is everything at once. The bureaucratic walls of the VA system. The culture that still equates seeking help with weakness. Years of being misdiagnosed, undermedicated, or handed a prescription and told good luck. And underneath all of that, a civilian mental health system that often does not understand what this population has actually been through.

That combination is why so many veterans and first responders reach me after years of doing everything right — therapy, medications, waiting lists — and still not being well. They followed the system. The system did not follow through.

Why I Built This Practice for This Population

It was not a business decision. When I look at who is underserved, who is falling through the gaps in Nebraska, and who deserves more than what the standard mental health system has offered them — the answer keeps pointing to the same people. Veterans. First responders. The ones carrying something that does not fit neatly into a fifty-minute therapy session or a standard antidepressant protocol.

My own service shaped how I think about duty, about showing up even when it is hard, and about what people deserve when they have given a significant part of themselves to something larger. That is what drove me to build a practice grounded in evidence, safety, and the kind of direct clinical honesty that this population responds to.

The One Thing That Changes the Conversation

When a veteran comes in skeptical about ketamine — and most of them are, because they have been let down before — the thing that tends to shift the conversation is this: ketamine does not require you to relive the trauma to work.

That matters more than I can overstate. Trauma-focused therapies are evidence-based and genuinely helpful for many people. But for a significant portion of veterans and first responders, the barrier to that work is the work itself. Re-exposure is too destabilizing. The dropout rates from trauma therapy in this population are well documented. Ketamine operates through a completely different mechanism — it does not ask you to go back. It works on the neurobiology of the brain directly, promoting neuroplasticity and interrupting the entrenched neural patterns that keep the nervous system locked in a trauma response. You do not have to tell me the story to start getting better.

What the Research Shows

A 2024 meta-analysis in Frontiers in Psychiatry (Liu et al.) synthesized 11 studies and 22 independent samples on ketamine specifically in military populations. The finding was significant — large, clinically meaningful reductions in PTSD, depression, and chronic pain outcomes, across different administration routes, dosing protocols, and both active-duty and veteran groups. A 2021 randomized controlled trial (Feder et al., American Journal of Psychiatry) found that 67% of patients receiving repeated IV ketamine infusions for chronic PTSD were classified as treatment responders — compared to 20% on placebo. Recent VA data from the San Diego Healthcare System found that ketamine and esketamine produced significant reductions in both depression and PTSD symptom scores across 119 veterans.

The evidence is not theoretical. It is real, it is peer-reviewed, and it is strong enough that the VA itself has been expanding ketamine programs nationally. As of 2024, more than two dozen VA medical centers have adopted ketamine protocols. Nebraska veterans have limited VA access to these treatments. That gap is part of why Parker Neuroscience exists.

Why Nebraska Specifically Has a Problem

It is not one thing. The VA system was not designed to move at the pace this population needs. Most civilian providers in Nebraska do not understand the military experience and cannot offer these treatments anyway. And the private ketamine market in Nebraska is thin — with significant variation in clinical standards between providers. The combination of those three gaps means that veterans and first responders in this state are often left with nothing that actually fits their situation.

Parker Neuroscience is not the VA, and it is not a ketamine lounge. It is a medically rigorous, REMS-certified, DNP-led interventional psychiatry practice that understands both the clinical picture and the human one.

Who I Built This For

The patients I built this practice for are the ones who have not given up despite having every reason to. The ones who are skeptical because they have been let down, but still made the appointment anyway. The ones who want someone to be straight with them — not sell them something, not manage them, not run them through a protocol and send them home. People who have spent years doing everything right and are still not well, and are willing to ask whether there is something they have not tried yet.

If that is you — or someone you know — the answer to that question is yes. There is something you have not tried yet. And it does not require you to go back through everything that broke you to get there.

The most common thing I hear from patients before a first consultation is some version of: "I am not sure I am a bad enough case for this."

Let me address that directly, because it reflects the single biggest misconception I encounter. People assume ketamine and Spravato are reserved for the most extreme presentations — suicidal crisis, inpatient stays, absolute last resort. The reality is more straightforward than that. These are evidence-based treatments for people who have tried the standard path and not gotten there. That is the threshold.

The other thing I hear often is an assumption that these treatments are still experimental — something on the frontier of psychiatry that serious clinicians are skeptical of. That is no longer true. The evidence base includes dozens of randomized controlled trials, multiple systematic reviews and meta-analyses, and FDA approval for esketamine. This is mainstream clinical psychiatry now. The question is not whether it works. The question is whether it is right for you specifically.

What a Good Candidate Actually Looks Like

The typical patient who is a strong candidate for ketamine or Spravato at Parker Neuroscience is someone who has been doing everything right for years and is still not well. They are not someone who gave up on treatment — they are someone who stayed with it, tried multiple medications, engaged with therapy, and kept showing up. The system just did not deliver.

Clinically, the primary indication is treatment-resistant depression — a major depressive episode that has not adequately responded to at least two antidepressants at adequate dose and duration. Spravato carries FDA approval for that specifically, and also for major depressive disorder with active suicidal ideation. Beyond depression, the evidence supports consideration of ketamine for chronic PTSD, treatment-resistant anxiety disorders including OCD, and carefully evaluated cases of bipolar depression.

The common thread is not severity — it is that the standard approach has run its course without sufficient result.

Factors That May Limit or Complicate Candidacy

I am going to be straightforward here because I think patients deserve that. The following conditions are either contraindications or require careful evaluation before we proceed:

• ●Active or past psychosis or schizophrenia — ketamine's dissociative effects can worsen psychotic symptoms
• ●Uncontrolled hypertension or glaucoma — ketamine raises blood pressure during infusion; we need cardiovascular stability first
• ●Active substance use disorder, including alcohol and kratom — not a permanent exclusion in most cases, but sobriety and stability are required before we start
• ●Pregnancy or breastfeeding
• ●Active mania — mood needs to be stabilized before interventional treatment begins
• ●Severe cardiovascular disease — requires thorough cardiac evaluation and clear risk-benefit conversation

Having one of these factors does not automatically end the conversation. It means we need more information. I have had patients come in with complicated histories where the right answer was not no — it was not yet, or we need to address X first. That is what a real clinical evaluation is for.

How I Approach the Consultation Differently

The first thing I do in a consultation that I believe sets Parker Neuroscience apart is tell you upfront what I can and cannot offer before we go any further. Not a pitch. Not a protocol walkthrough. A direct statement of what this practice does, what it does not do, and what my honest clinical read is on whether you are in the right place.

That means if I do not think you are a candidate, I will tell you — and I will try to help you understand what the right next step actually is. It also means if I think you are a strong candidate and have been waiting longer than you needed to, I will tell you that too.

What I do not do is run every inquiry through the same intake funnel and assume treatment is the answer before we have actually talked. Twenty years in emergency medicine taught me that the most important clinical skill is reading a patient accurately before doing anything at all.

The Bottom Line

If you have been doing everything right — following the treatment plan, taking the medications, showing up to therapy — and you are still not where you need to be, you are probably the person this practice was built for. Not because I am promising results. Because you deserve a real clinical evaluation from someone who will be straight with you, and because the evidence supporting these treatments is strong enough that not exploring them is a genuine clinical oversight.

The consultation is where it starts. I am in Omaha, Nebraska. And I will tell you the truth about what I think.

Governments, industry, and philanthropies are pouring money into neuroscience at an unprecedented scale — all with the noble goal of reducing brain disease and extending healthy cognitive life. The "brain health" movement wants to do for the brain what oncology and cardiology have already accomplished: catch problems early, intervene aggressively, and prevent irreversible damage.

But a critical blind spot is forming. As policies increasingly pivot toward Alzheimer's disease and other neurodegenerative disorders, mental illness is being pushed aside as a secondary concern — rather than recognized as a core component of brain health.

A brain that cannot regulate mood or perception is not, by any meaningful definition, a healthy one.

Mental Illness Drives Neurodegeneration

The authors argue that if the goal is to solve the Alzheimer's crisis, the field cannot afford to ignore psychiatry. Conditions like chronic depression and substance use disorders are not merely comorbidities — they are significant drivers of cognitive decline and late-life neurodegeneration. Psychiatric symptoms such as anxiety, depression, and psychosis often appear before memory loss, and are linked to faster decline, higher rates of institutionalization, and increased mortality.

From a biological standpoint, untreated psychiatric conditions erode the brain's structural integrity over time, leaving neurons more vulnerable to the "second hit" that triggers Alzheimer's or Parkinson's disease.

Key Takeaways

• ►Depression carries a comparable — sometimes higher — risk for dementia than cardiovascular disease, yet it remains underappreciated as a modifiable risk factor.
• ►Psychiatric symptoms often precede memory or motor loss and are associated with faster cognitive decline and higher mortality.
• ►Early treatment of psychiatric illness may delay the onset of neurodegeneration by reducing cumulative biological stress on the brain.
• ►Psychiatric conditions account for a disproportionate share of global disability because they strike early and persist across the lifespan.
• ►The authors call for comprehensive screening, precision-medicine approaches to psychiatry, and unified national brain health initiatives that include mental illness.

An Artificial and Outdated Divide

For decades, neurology has been seen as the domain of "organic" disease — conditions visible on scans or under a microscope — while psychiatry has been cast as something shaped more by environment and psychology than biology. The authors argue this distinction no longer holds up scientifically. The fundamental processes governing brain health — genetics, neural plasticity, neuroinflammation — do not respect the boundary drawn between neurology and psychiatry. Bipolar disorder is as biological as multiple sclerosis; schizophrenia is as disruptive to neural circuits as many recognized neurological conditions.

What Needs to Change

The authors outline three priorities: broader screening that evaluates emotional regulation as rigorously as memory and movement; precision-medicine research in psychiatry to identify biomarkers and move beyond symptom-based diagnosis; and unified national brain health frameworks that include mental illness alongside Alzheimer's and other neurodegenerative conditions.

The success of focused federal investment in Alzheimer's — through legislation like the National Alzheimer's Project Act — provides a blueprint. Applying the same level of sustained, bipartisan commitment to serious mental illness, the authors argue, would produce comparable results.