People who come to Mind Spa after years of treatment often describe the same thing. They understand what is happening to them. They can name their triggers, explain their thought patterns, and repeat what their therapist would say. But knowing it and feeling different are two separate things, and their brain and body do not always follow along.
Inner Armor is built around that gap. It is a 7 to 12 week program that combines three brain-directed treatments, transcranial magnetic stimulation (TMS), IV ketamine, and hyperbaric oxygen therapy (HBOT), with trauma-informed therapy and medication management as needed. This post explains the reasoning behind stacking them, what the research says about each one, and where that evidence is still thin.
One point up front, because it shapes everything else: the strongest evidence is for each treatment on its own, in the conditions where it has been studied. Research on combining them is early, and for all three together it is more rationale than tested result.1
Mind Spa uses the Apollo TMS Therapy System, which is FDA-cleared for major depressive disorder and obsessive-compulsive disorder (OCD). TMS for post-traumatic stress disorder (PTSD), anxiety, and traumatic brain injury (TBI) is off-label. IV ketamine is FDA-approved as an anesthetic. Its use for depression, PTSD, and anxiety is off-label, and the only FDA-approved ketamine-based treatment for depression is esketamine (Spravato) nasal spray. HBOT is not FDA-cleared for PTSD, TBI, depression, anxiety, cognitive decline, or aging. Those uses are investigational.
For depression, TMS usually targets the left dorsolateral prefrontal cortex (DLPFC), a region near the front of the brain involved in mood and in the deliberate, top-down control that helps people steer their attention and reactions. In a large multisite trial, daily left prefrontal TMS produced a statistically significant antidepressant effect compared with sham, a look-alike procedure with no active stimulation.2 A 2021 review reports that real-world clinical data support its effectiveness for depression as well.3
The same region shows up in PTSD research. In a neuroimaging study, women with PTSD showed less lateral prefrontal activation than comparison participants while anticipating upsetting images, and those with greater DLPFC activation had less severe symptoms.4 That link is one reason TMS is studied beyond depression, though its use for PTSD remains off-label. In Inner Armor, the TMS course is 36 sessions, five days a week.
Ketamine works through a different door. In studies of treatment-resistant depression, it has been associated with rapid antidepressant effects, sometimes within hours or days.5 Current models describe it blocking one type of glutamate receptor, the NMDA receptor, which sets off a surge of signaling through another, the AMPA receptor. Laboratory and translational research points downstream to brain-derived neurotrophic factor (BDNF) and the mTOR pathway, both involved in building new connections between neurons.6
That is the window Inner Armor is designed around: a period when the brain may be more open to new learning. At Mind Spa, a series is six infusions over two to three weeks. A nurse stays in the room one-on-one for each infusion, patients lie on a vibroacoustic sound table, and afterward they can turn the experience into an AI-generated image to bring into therapy.
Under pressure, far more oxygen dissolves into plasma, the liquid part of the blood, than breathing at normal pressure allows. That can raise oxygen delivery to tissue beyond what red blood cells carry alone.7 Mind Spa uses a hard-sided chamber at 2.0 atmospheres absolute (ATA), with sessions of 60 or 90 minutes.
The brain research is mixed, and both sides deserve a look. In a randomized trial of people with lasting symptoms years after a concussion, HBOT was followed by better cognitive scores and quality of life, and brain imaging showed increased blood flow that the authors described as consistent with neuroplasticity, the brain's capacity to change its connections.8 A small uncontrolled study reported imaging changes tied to new blood vessel growth.9 But trials differ widely in pressure, dose, and what they used as a sham, and a 2022 systematic review stresses that those details decide how the results should be read.10 In animal research, HBOT reduced inflammation in the brain after injury in rats.11
For PTSD, a 2024 randomized, sham-controlled trial in combat veterans reported improvements in symptoms and changes in brain connectivity after HBOT. It used 60 sessions, more than Inner Armor's 36, and it still needs to be replicated.12
The program is designed around four targets.
Inflammation. A meta-analysis found higher levels of several inflammatory markers in people with PTSD than in people without it.13 Depression and inflammation appear to feed each other.14 The idea is not that inflammation causes everything. It is that inflammation may influence how severe symptoms get, and how well treatment works, for some patients.
Neuroplasticity. Repetitive TMS shows evidence of plasticity-like changes, a strengthening of connections between neurons, along with measurable shifts in how brain networks communicate.15 Ketamine adds a faster, different kind of plasticity.5
Energy and blood flow. HBOT is studied for its effects on blood flow and on the signals tied to new blood vessel growth.8,9
Regulation through therapy. The prefrontal cortex plays a central role in regulating fear and threat.16 Trauma-informed therapy is where the work of building new coping skills and new responses happens. The other three treatments are meant to support that work, not replace it.
Timing is the other reason. Standard antidepressants take weeks to reach full effect. In the first step of the large STAR*D study, fewer than a third of patients reached remission on their first antidepressant, and many who did needed several weeks to get there.17 Inner Armor pairs a treatment studied for rapid effects, ketamine, with one delivered over several weeks, TMS, alongside HBOT and therapy. That sequencing is a design hypothesis, not an established result.
What does the combination research show so far? A 2024 systematic review of TMS plus ketamine for treatment-resistant depression found mostly case reports, retrospective studies, and small samples.1 The signal is promising, but it is not the same as large randomized trials.
Inner Armor runs 7 to 12 weeks: 36 TMS sessions, 6 ketamine infusions, and 36 HBOT sessions, plus medication management and therapy as needed.
It is open to TRICARE Prime, Select, and Reserve Select beneficiaries who meet clinical criteria, including spouses and dependents on those plans. Because TRICARE covers TMS for major depressive disorder, the program starts with a depression diagnosis that meets TRICARE's criteria. Many people who qualify also live with PTSD, anxiety, or the lasting effects of a brain injury. TRICARE For Life is not eligible for Inner Armor, though TRICARE For Life patients are welcome for TMS through Medicare. Learn more on our veterans page.
Colorado is in the TRICARE West Region, and Inner Armor happens at our clinic in Greenwood Village, just south of Denver. Because the program means weekday visits for several weeks, the drive is part of the plan. From Aurora, Centennial, Littleton, Lakewood, Parker, or Castle Rock, the clinic is a short trip. From Colorado Springs or Fort Collins, plan on about an hour each way on I-25. We plan the schedule with you at your consult.
Inner Armor is usually most relevant for people whose depression has not responded enough to medication and therapy, especially when it comes with PTSD symptoms like hyperarousal and intrusive memories, anxiety that shows up strongly in the body, or slowed thinking, fatigue, and poor sleep after a brain injury.
It is not for everyone. Ketamine and HBOT both require careful medical screening, and some medical conditions and medications rule one or both out. Each treatment has side effects: scalp discomfort and headache with TMS; dissociation, nausea, and a temporary rise in blood pressure during a ketamine infusion; and ear pressure or barotrauma, sinus discomfort, and fatigue with HBOT. Our team reviews all of it with you before you start.
Not yet. Evidence for TMS plus ketamine is emerging but rests mostly on small studies. Evidence for all three together is more rationale than tested result.1
No. HBOT is not FDA-cleared for either, and those uses are investigational. Some trials report improvements and others do not, and reading them well depends on the protocol each one used.10
In treatment-resistant depression research, some patients improve within hours or days. How long the effect lasts varies, and keeping the benefit usually takes an ongoing treatment plan.5
To find out whether Inner Armor fits your situation, Book A Consult or call 303-327-0350. Mind Spa is at 5340 S Quebec St Ste 230S, Greenwood Village, CO 80111, just south of Denver with easy access from I-25 and I-225. We are open Monday to Friday, 9am to 5pm.
Mind Spa is an independent clinic in network with TRICARE West. Mind Spa is not affiliated with or endorsed by TRICARE, the Defense Health Agency, or the Department of Veterans Affairs. Ketamine infusions and HBOT sessions in Inner Armor are funded for eligible Inner Armor patients through Mind Spa's nonprofit partners. Standard TRICARE copays and cost-shares apply to TMS and other TRICARE-covered care. We review your expected costs with you before you begin. Individual results vary and are not guaranteed.
