Do I have to tell you about the assault or abuse?

No. Our intake asks medical questions: diagnoses, medications, heart and blood pressure history, past reactions to anesthesia, and symptoms such as dissociation, panic, or nightmares. “I have a sexual trauma history and would rather not go into it” is a complete answer. If certain things tend to set off your alarm system, such as lying flat, unannounced touch, or a closed door, you can name them without explaining why.

What happens if I feel unsafe during an infusion?

Before your first session we agree on a stop signal and the grounding steps you would like offered. A clinician is in the room, and Marla Peterson, CRNA, oversees every infusion with anesthesia-level monitoring of oxygen, blood pressure, and heart rate throughout. If you use your signal, we respond: the infusion can be slowed or paused, the eye mask lifted, the lights brought up, or the music changed.

How is ketamine different from trauma therapy or antidepressants?

Trauma-focused therapies such as cognitive processing therapy, prolonged exposure, and EMDR remain first-line treatments for PTSD, and daily antidepressants are a common medication option. Ketamine works through a different pathway, the NMDA glutamate receptor, and research suggests it can act within hours to days rather than weeks. It is best thought of as a possible adjunct to therapy, not a replacement for it, and its use for PTSD is off-label.

How long before I know whether ketamine is helping?

In the 2021 Feder trial, outcomes were measured after six infusions over two weeks, and most patients here begin with a similar series of six infusions over two to three weeks. We review how you are doing as the series goes. Some people notice change within the first few sessions; some do not respond. If it is not helping, we will say so honestly and talk through next steps with you and your therapist.

Can I bring someone with me?

Yes. You are welcome to bring a trusted partner, friend, or family member to your consultation, and we can talk about whether and how a support person fits into infusion days. You decide who knows what, and we will never share your history with anyone without your written consent.

Ketamine for sexual trauma survivors: consent, control, and what the evidence shows

Why sexual trauma deserves its own conversation

Any trauma can leave a mark, but sexual violence carries a particular weight in the research. In the landmark National Comorbidity Survey, published in the Archives of General Psychiatry in 1995, Kessler and colleagues found that about 10% of women and 5% of men met criteria for PTSD at some point in their lives. Among women with PTSD, rape or sexual molestation was the trauma most closely tied to their symptoms in roughly half of cases.

A 2021 meta-analysis in Trauma, Violence, & Abuse by Dworkin and colleagues pooled 22 prospective studies of 2,106 survivors of sexual assault. About 75% met criteria for PTSD one month after the assault. That fell to 54% at three months and 41% at twelve months, with most of the natural recovery happening in the first three months. The hopeful part is that many people do recover. The harder part is that for a large minority, symptoms settle in and stay.

Survivors are not one group. Some were assaulted as adults, some were abused as children, some in the military, and some by a partner. Survivors are women, men, and nonbinary people. If your history includes childhood abuse, our article on ketamine for childhood trauma goes deeper, and combat PTSD versus military sexual trauma covers the military context.

Why a medical room can feel different after sexual trauma

Sexual trauma is, at its core, a violation of the body and of consent. That makes ordinary parts of medical care feel loaded in ways other patients may never notice. Lying back in a reclined chair. A stranger placing an IV in your arm. A blood pressure cuff tightening without warning. A closed door. An eye mask. A medicine that changes how your body and surroundings feel.

Many survivors also carry shame or self-blame that has nothing to do with what actually happened, and they may never have told anyone the full story. Some have had medical experiences since the assault that made things worse. None of this is a reason to avoid treatment. It is a reason to expect a clinic to slow down, explain what it is doing, and ask first. We describe our general approach in what trauma-informed ketamine care looks like at MCK; this article focuses on what that means after sexual trauma.

How ketamine may help a stuck stress response

PTSD is increasingly understood as a problem of learning that got stuck. The brain's threat system keeps firing as if the danger were still present, and the circuits that should help it update, especially in the prefrontal cortex and hippocampus, become less flexible. Chronic stress is associated with a loss of synaptic connections in those regions.

Ketamine blocks the NMDA receptor, a gateway for the neurotransmitter glutamate. Research suggests this triggers a brief surge of glutamate signaling through a different receptor, AMPA, followed by the release of growth factors such as BDNF and the formation of new synaptic connections. The working hypothesis is that this opens a window of greater neuroplasticity, a period when the brain may be more able to loosen old patterns and take in new learning. That hypothesis is one reason we encourage pairing infusions with therapy rather than relying on the medicine alone.

What the clinical research shows, and what it does not

Ketamine is FDA-approved as an anesthetic; its use for PTSD, including PTSD after sexual trauma, is off-label. The evidence base is real but still modest, and it has mixed results.

Feder and colleagues, JAMA Psychiatry (2014). In a randomized crossover trial, 41 adults with chronic PTSD received a single infusion of ketamine or midazolam. Ketamine produced a significantly greater reduction in PTSD symptoms at 24 hours, along with improvement in depressive symptoms.
Feder and colleagues, American Journal of Psychiatry (2021). Thirty adults with chronic PTSD received six infusions over two weeks. Sixty-seven percent of the ketamine group met the response threshold, compared with 20% on midazolam, and among responders the benefit lasted roughly four weeks after the series ended.
Abdallah and colleagues, Neuropsychopharmacology (2022). In 158 veterans and service members whose PTSD had not responded to antidepressants, eight twice-weekly infusions added to existing treatment did not separate from placebo on PTSD symptoms, although the standard dose did improve depression.

Two honest caveats follow. First, none of these trials studied sexual trauma survivors as a separate group, so we cannot say whether results differ by type of trauma. Second, the mixed findings mean ketamine helps some people with PTSD and not others. Our overview of ketamine for PTSD walks through the broader evidence, and the PTSD page gathers related reading.

Consent before, during, and after an infusion

SAMHSA's 2014 guidance on a trauma-informed approach names principles that include safety, trustworthiness and transparency, and empowerment, voice, and choice. After sexual trauma, those principles come down to something concrete: consent is not a form you sign once. It is a conversation that continues the whole way through. In practice, that means:

No disclosure required. You never have to describe what happened. You can name triggers without explaining them.
Narrated touch. We tell you before we touch you, whether that is placing the IV or adjusting a sensor, and we ask before any reassuring hand on the shoulder. “No” is always a full answer.
Positioning and the room. You can sit more upright, keep a blanket over you, keep your shoes on, and tell us how you feel about the door. If you have preferences about who is in the room, tell us and we will be honest about what we can accommodate.
The eye mask is optional. Many survivors feel safer able to see the room. You can wear it, skip it, or lift it any time.
A stop signal. We agree in advance on a word or gesture that means “check on me” or “slow down,” and the infusion can be slowed or paused.

Ketamine's dreamlike, dissociative effects are a common worry for people whose minds learned to dissociate in order to survive. We talk about this before the first session, often start trauma-sensitive patients at a lower dose, and agree on grounding steps in advance. Our explainers on dissociation during ketamine and whether ketamine can cause flashbacks address these fears directly.

Therapy remains the foundation

Trauma-focused therapies, including cognitive processing therapy, prolonged exposure, and EMDR, remain first-line treatments for PTSD. Ketamine is not a replacement for that work. For trauma presentations, we generally recommend having a licensed therapist in place before starting infusions, so that whatever opens up has somewhere safe to go. With your written consent, we coordinate timing so an integration session can fall within a few days of an infusion. If you are looking, our guide to finding an integration therapist in Tennessee is a practical starting point, and if nightmares are part of the picture, see ketamine for trauma nightmares.

Never start, stop, or change a medication on your own because of anything you read here. Talk with your prescribing provider first.

What to expect at Music City Ketamine

It starts with a consultation, which is simply a conversation. You are welcome to bring someone you trust; our article on bringing a partner or family member to your consultation explains how that works. We review your medical history, medications, and blood pressure, and we screen for conditions where ketamine is not appropriate.

If ketamine looks like a reasonable fit, most patients begin with a series of six infusions over two to three weeks. Each infusion is CRNA-led: Marla Peterson, CRNA, oversees every infusion with anesthesia-level monitoring of oxygen saturation, blood pressure, and heart rate, and a clinician is in the room. Learn more about what a CRNA is. You will need someone to drive you home afterward. Our two Old English Sheepdogs, Walter White and Wilma, are part of the welcome, and they are entirely optional.

Honest expectations

Ketamine does not erase memories, and it does not undo what happened. What some people describe instead is that the memories lose some of their grip, which can make therapy feel more workable. Others notice little change, and some do not respond at all. The benefit from an initial series may fade over weeks, and some patients use occasional maintenance infusions while others do not need them.

Because use for PTSD is off-label, insurance generally does not cover it. Sessions are $475 each. If you are in crisis or thinking about suicide, call or text 988, the Suicide & Crisis Lifeline, or call 911. For confidential support after sexual violence, the RAINN National Sexual Assault Hotline is available 24/7 at 800-656-4673. For the full picture of how we approach trauma, visit our Trauma & Grief page.