Ketamine Assisted Psychotherapy (KAP) in Nashville

Ketamine assisted therapy pairs a low dose of ketamine with psychotherapy. The medicine is one part. The therapy built around it is the other, and in this model the two are not separable.

If you are researching ketamine for the first time, or comparing what we do against an infusion clinic, this page covers what the treatment is, how our process works, what it costs, what the evidence supports, and who should not do it.

What ketamine is, and where it stands

Ketamine is a dissociative anesthetic that has been used in medicine since it received FDA approval in 1970. It is a Schedule III controlled substance, meaning it is legal to prescribe and also carries recognized potential for misuse.

Ketamine is not FDA approved for depression, PTSD, anxiety, OCD, or any other psychiatric condition. When used for those purposes, including here, that use is off label. Off-label prescribing is legal and common throughout American medicine. It also means the FDA has not evaluated ketamine for these uses and has not determined that it is safe and effective for them.

One related exception: esketamine, sold as Spravato, was approved in 2019 for treatment-resistant depression and in 2020 for major depressive disorder with acute suicidal ideation. It is a different medication given under a different protocol, and it is not what we offer.

What the research does and does not show

Research on ketamine’s rapid antidepressant effects is substantial and well documented. Some people experience relief within hours rather than the weeks typical of conventional antidepressants, including people who have not responded to other treatments.

Research on ketamine combined with structured psychotherapy specifically is thinner. Studies to date have largely been small, open label, or retrospective. Larger controlled trials are underway. Whether adding therapy improves or extends the effect is an active research question with encouraging early findings and no settled answer.

We would rather tell you that plainly than promise you an outcome. If a provider describes ketamine to you as proven, safe and effective, or a breakthrough cure, that is a marketing claim rather than a clinical one.

How our process works

Ketamine assisted therapy here is a sequence, not an appointment. The dosing session is just a part of it.

Consultation and treatment planning. If you are not currently working with Melanie, or it has been twelve or more months since your last session, this comes first. Typically forty-five minutes. We look at your history, what you are hoping for, and whether this is the right moment for your nervous system. Some people leave this session deciding not to proceed, or to wait. That is a legitimate outcome and a common one.

Medical screening. The prescribing provider conducts an independent evaluation covering cardiovascular health, blood pressure, psychiatric history, current medications, and substance use history. This is a medical decision made by a medical provider.

Preparation sessions. Typically one to one and a half hours each; the number depends on your needs. We talk about what you want from the experience, what you are afraid of, what happens if something difficult arrives, and how you are getting home. Preparation is not a formality. In our experience it is the strongest predictor of whether a dosing session goes somewhere useful.

Dosing sessions. Approximately two hours. Ketamine is administered by the prescribing medical provider as an intramuscular injection in the upper arm. Most people lie down with an eye mask and music. The therapist remains in the room for the entire session; present and tracking you. The approach is largely inner-directed, meaning she is not steering or questioning, but she is trained to work with what surfaces, including with Brainspotting, EMDR, somatic therapy, narrative therapy or parts work, depending on what the moment calls for. You cannot drive afterward and will need someone to take you home.

Integration sessions. This is where most of the therapeutic work happens. Whatever surfaced gets made sense of, connected to your life, and worked with. Ketamine can loosen material; integration is what turns loosened material into change. Skipping this step is the most common way people spend significant money and end up roughly where they started.

Ongoing planning. A series of dosing sessions is typical, each with support around it. The number is determined in treatment planning rather than promised in advance.

Collaboration with a medical provider

Melanie works in collaboration with a Psychiatric Mental Health Nurse Practitioner. The prescriber handles medical screening and administration independently, as is appropriate to their license. Melanie handles the therapeutic work. Both work from a shared treatment plan and adjust it together.

That coordination is a meaningful difference from models where medical and psychological care never speak to each other.

Who this may be a fit for

People working with depression, anxiety, PTSD and complex trauma, OCD, or chronic pain, particularly those who have not found sufficient relief through other approaches, and who are able to commit to the preparation and integration work rather than the dosing alone.

Fit is determined through consultation and medical screening, not from a single conversation.

Who this is not for

Ketamine assisted therapy is not appropriate for everyone, and there are conditions where it carries real risk.

Medical considerations include: uncontrolled high blood pressure and certain cardiovascular conditions, a history of psychosis or certain presentations of bipolar disorder, pregnancy, some liver conditions, increased intracranial or intraocular pressure, and active substance use involving ketamine or other substances. Some medications interact with ketamine. The prescribing provider evaluates all of this individually.

Timing considerations include: acute crisis, lack of stable housing or support at home, or inability to commit to integration sessions. Any of these may mean other work should come first.

Dissociation deserves particular thought. For people who already dissociate readily, a medicine that produces dissociative states requires careful consideration rather than enthusiasm.

Our screening is deliberately conservative. If we tell you no, or not yet, it is not a judgment about you.

A fuller overview is available here: Contraindications to Ketamine Assisted Therapy

Risks and side effects

During and shortly after a session: nausea, elevated blood pressure and heart rate, dizziness, blurred or double vision, disorientation, and psychologically difficult experiences. Nausea is common enough that we plan for it.

With frequent or high-dose use over time: bladder and urinary tract problems, cognitive effects, and potential for psychological dependence. This is one reason we use a structured, spaced protocol with clinical oversight, and one reason we do not support unmonitored at-home models.

A note on at-home ketamine. Several telehealth companies mail compounded ketamine lozenges for use at home with little or no monitoring. The FDA has warned that use of compounded ketamine without a provider monitoring for sedation, dissociation, and changes in vital signs may put patients at risk of serious adverse events, and that compounded products are not FDA approved. We do not work this way.