Post-traumatic stress disorder can affect sleep, concentration, mood, relationships, physical tension, and a person’s sense of safety long after a traumatic event has ended. Evidence-based trauma-focused therapies can be highly effective, but some people continue to experience significant symptoms or find that their treatment plan needs to be reassessed.
For patients in Houston whose PTSD symptoms have not improved as expected, the next step is not to assume that therapy has failed or that there are no remaining options. At our Bellaire clinic, we look at the full picture: trauma history, current symptoms, prior treatment, coexisting conditions, sleep, medication response, and daily functioning.
Trauma-Focused Therapy Remains an Important Foundation
PTSD is more than a stressful memory. It can involve intrusive thoughts, nightmares, avoidance, hypervigilance, emotional reactivity, changes in mood, and difficulty feeling safe or connected to others.
Trauma-focused psychotherapies, including Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing, have the strongest evidence base for PTSD. These treatments can help people process trauma, reduce avoidance, and build skills for managing distress.
Still, treatment is not identical for everyone. Some patients may not have had access to PTSD-specific therapy, may have had difficulty completing treatment, may have only experienced a partial response, or may be dealing with depression, anxiety, sleep disruption, substance use, chronic pain, or other conditions that complicate recovery.
Our ketamine-assisted psychotherapy services can be part of a broader plan for patients who need additional support, including trauma-informed therapy options and coordination with an existing therapist when appropriate.
A Comprehensive Evaluation Looks Beyond PTSD Symptoms
Persistent PTSD symptoms do not necessarily mean that one treatment approach is inherently ineffective. They may signal a need to revisit the diagnosis, treatment history, coexisting conditions, medication plan, or the practical barriers that can make treatment difficult to sustain.
At our practice, we take time to understand symptoms over the course of a person’s life. We ask about trauma-related symptoms, mood changes, anxiety, sleep, prior therapy, medication experiences, medical history, substance use, and the impact symptoms have had on work, relationships, and daily responsibilities.
This kind of evaluation can help identify whether PTSD is the primary concern, whether depression or another condition is also affecting recovery, or whether a treatment plan needs to be more clearly coordinated across providers.
What IV Ketamine Can—and Cannot—Address
IV ketamine infusion therapy is offered at our clinic and may be discussed after a careful psychiatric and medical evaluation. Its psychiatric use is off-label, including for PTSD.
Some small studies and systematic reviews have reported short-term reductions in PTSD symptoms for selected patients, but the research remains limited and findings have not established IV ketamine as standard PTSD care. Current clinical guidelines are cautious about its use for PTSD, and it should not replace evidence-based trauma-focused psychotherapy.
For patients with PTSD and coexisting treatment-resistant depression, IV ketamine may be considered only as part of an individualized plan. We review treatment history, current medications, medical factors, symptom severity, potential risks, and realistic expectations before discussing whether it may be clinically appropriate.
No intervention is right for every person, and IV ketamine should not be presented as a cure for PTSD or as a substitute for ongoing trauma-informed care.
The Role of Deep TMS When Depression Is Also Present
Deep TMS is delivered using an FDA-cleared device for specific conditions, including major depressive disorder and OCD. It is not FDA-cleared as a treatment for PTSD.
Research on TMS for PTSD is still developing, and there is not enough evidence to establish it as a standard PTSD intervention. However, when a patient has PTSD alongside a separately evaluated depressive disorder for which Deep TMS is appropriate, treatment for depression may be one part of a broader psychiatric plan.
That distinction matters. Deep TMS may be considered for a qualifying depressive condition, but it should not be described as a direct treatment for PTSD or expected to resolve trauma-related symptoms on its own.
When PTSD and Treatment-Resistant Depression Occur Together
PTSD and depression commonly occur together. When depression has not responded adequately to prior treatment, it can worsen fatigue, withdrawal, hopelessness, sleep problems, concentration, and the ability to engage consistently in therapy.
For adults with separately diagnosed treatment-resistant depression, SPRAVATO® treatment may be another option to discuss. SPRAVATO® is FDA-approved for treatment-resistant depression, not PTSD, and it is administered under medical supervision through a restricted REMS program.
The purpose of evaluating treatment-resistant depression is not to shift attention away from PTSD. It is to make sure that coexisting symptoms are not left untreated and that each part of a patient’s clinical picture is addressed appropriately.
PTSD Care Should Not Be One-Size-Fits-All
For some people, the greatest barrier to care is avoidance, fear, exhaustion, or the difficulty of recounting painful experiences to another person. For others, it is fragmented treatment across multiple providers, incomplete records, financial concerns, or uncertainty about what has already been tried.
We approach PTSD evaluations with care and without assumptions. A treatment plan may include trauma-focused psychotherapy, medication review, treatment for coexisting depression or anxiety, sleep-focused support, referral coordination, or other services based on the individual’s needs.
Our psychiatric treatment services are designed for patients with complex and persistent symptoms who need a more complete review of their care history.
Frequently Asked Questions
Does IV ketamine help PTSD?
Some studies have reported short-term symptom improvement for selected patients, but the evidence remains limited and current clinical guidelines are cautious about using IV ketamine for PTSD. Its psychiatric use is off-label, and it should not replace evidence-based trauma-focused therapy. A thorough evaluation is necessary before considering whether it has a role in an individual treatment plan.
What is the difference between ketamine and EMDR for PTSD?
EMDR is a trauma-focused psychotherapy with an established role in PTSD treatment. IV ketamine is an off-label medical intervention that has been studied for PTSD but is not an established first-line treatment. They are not interchangeable, and a patient’s treatment plan should be based on diagnosis, treatment history, symptoms, goals, and safety considerations.
Can Deep TMS help with PTSD?
Deep TMS is not FDA-cleared for PTSD, and research in PTSD remains insufficient to establish it as standard care. It may be considered when a patient also has a separately diagnosed condition, such as treatment-resistant depression, for which the treatment is appropriate.
How many ketamine infusions are needed for PTSD?
There is no FDA-approved IV ketamine treatment schedule for PTSD. Any discussion of treatment frequency should follow an individualized psychiatric and medical evaluation, with clear attention to the limited evidence, potential risks, and the need for ongoing trauma-focused care.
What if I am already working with a therapist for PTSD?
Continuing with an experienced trauma therapist is often an important part of care. We encourage patients to maintain communication with their existing providers when appropriate and can consider how psychiatric treatment, medication review, and therapy may fit together.
Key Takeaways
- Trauma-focused psychotherapy remains a central, evidence-based treatment for PTSD.
- Persistent symptoms may indicate a need to reassess treatment history, coexisting depression or anxiety, sleep, medication response, and barriers to care.
- IV ketamine is off-label for PTSD, and the current evidence does not establish it as standard PTSD treatment.
- Deep TMS is not FDA-cleared for PTSD; it may be considered only for separately evaluated conditions for which it is appropriate.
- SPRAVATO® is FDA-approved for treatment-resistant depression, not PTSD.
- A comprehensive evaluation can help clarify which parts of a treatment plan may need to change.
Conclusion
If you have been through therapy for PTSD and are still carrying significant symptoms, it may be worth taking a closer look at the full clinical picture. Persistent symptoms do not mean that you have failed treatment or that there are no remaining options.
At our Bellaire clinic, we work with patients facing complex psychiatric concerns, including PTSD alongside depression, anxiety, sleep disruption, or treatment-resistant symptoms. To discuss whether a comprehensive evaluation may be appropriate, contact us to schedule a consultation.
About Dr. Sandhya Prashad
Dr. Sandhya Prashad, M.D. is a board-certified psychiatrist and the founder and medical director of Sandhya J. Prashad, MD, Houston Ketamine Therapeutics, and Houston TMS Therapeutics. Her practice focuses on treatment-resistant depression and interventional psychiatric care, including IV ketamine therapy, SPRAVATO®, Deep TMS, therapy services, and comprehensive psychiatric evaluation.
Works Cited
Almeida, T. M., Lacerda da Silva, U. R., Pires, J. P., Borges, I. N., Martins, C. R. M., Cordeiro, Q., & Uchida, R. R. (2024). Effectiveness of ketamine for the treatment of post-traumatic stress disorder: A systematic review and meta-analysis. Clinical Neuropsychiatry, 21(1), 22–31.
U.S. Department of Veterans Affairs & U.S. Department of Defense. (2023). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder.
U.S. Food and Drug Administration. (2012). BrainsWay Deep TMS System: 510(k) summary (K122288).
U.S. Food and Drug Administration. (2018). BrainsWay Deep Transcranial Magnetic Stimulation System: De Novo classification summary (DEN170078).
U.S. Food and Drug Administration. (2025). SPRAVATO® prescribing information.
Medical Disclaimer
This blog is provided for educational purposes only and does not constitute medical advice. The information presented here is not intended to diagnose, treat, cure, or prevent any condition. Individual results vary, and the treatments described may not be appropriate for every patient. Please discuss your symptoms and treatment options with a qualified psychiatric provider before making any medical decisions. If you are experiencing a psychiatric emergency or are in crisis, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.