The Impact of Ketamine for Treatment of Post-Traumatic Stress Disorder: A Systematic Review With Meta-Analyses

Summary & key facts

Researchers looked at studies that tested ketamine for people with post-traumatic stress disorder, and they found about six good-quality trials. Overall, ketamine lowered PTSD and depression scores quickly — sometimes within a day — and these benefits lasted up to about four weeks in the studies. The improvement was small to modest, came with some short-term side effects like dry mouth and dizziness, and the researchers said ketamine is not clearly better than standard antidepressant drugs for long-term use.

Key facts:

• The review found about six randomized controlled trials that tested ketamine in people with PTSD.
• Researchers combined results measured on common PTSD and depression scales. Compared with control treatments, ketamine lowered clinician-rated PTSD scores by about 11 points on average and self-reported PTSD scores by about 6 points at the longest follow-up times reported.
• Depression scores dropped by about 6 points on average with ketamine compared with control at the trials' longest follow-up times.
• Some benefit showed up very quickly. Improvements were seen as early as the first day after ketamine and at weeks 1, 2, and 4 on PTSD measures in the trials.
• In the studies that reported relapse, people given ketamine took about 16 days longer to relapse from PTSD symptoms than people given control treatments.
• Common short-term side effects that were more likely with ketamine than control included dry mouth, dizziness, and blurred vision in the trials that reported them.
• The authors noted the effect was modest and similar in size to what is seen with standard antidepressant drugs like SSRIs and venlafaxine, so ketamine would not replace those treatments for ongoing, long-term care based on current evidence.
• The reviewers said the lasting benefit beyond the first few weeks is still unclear and needs more study.

Abstract

BACKGROUND: Ketamine has been used in anesthesia, pain management, and major depressive disorder. It has recently been studied in patients with post-traumatic stress disorder (PTSD). OBJECTIVE: To determine the impact of ketamine on PTSD symptomatology and depression scores. METHODS: We conducted a literature search of Medline 1960 to May 20, 2023, and found 6 randomized controlled trials that met our inclusion criteria. We extracted data on the Clinician-Administered PTSD (CAPS), PTSD Checklist (PCL), or Montgomery-Asberg Depression Rating (MADRS) scales. RESULTS: The use of ketamine significantly reduced CAPS scores (n = 5, MD: -10.63 [95% CI -14.95 to -6.32]), PCL scores (n = 3, MD: -6.13 [95% CI -8.61 to -3.64]), and MADRS scores (n = 3, MD: -6.33 [95% CI -8.97 to -3.69]) at the maximal follow-up times versus control. Significant benefits were found at day 1 and weeks 1, 2, and 4 for CAPS and PCL scores as well as MADRS scores at day 1, week 1, and week 4 for ketamine versus control. The time to PTSD relapse was prolonged in the patients receiving ketamine versus control (n = 2, 15.74 days [95% CI 3.57 to 29.91 days]). More dry mouth (n = 2, OR 5.85 [95% CI 1.32 to 25.95]), dizziness (n = 2, OR 3.83 [95% CI 1.28 to 11.41]), and blurred vision (n = 2, OR 7.57 [1.00 to 57.10]) occurred with ketamine than control therapy. CONCLUSIONS AND RELEVANCE: Ketamine modestly reduced PTSD and depression scores as early as 1 day of therapy, but the longevity of effect needs to be determined. Given similar magnitude of benefit with SSRIs and venlafaxine, ketamine would not supplant these traditional options for chronic use.

Topics

Anesthesia and Neurotoxicity Research Posttraumatic Stress Disorder Research Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Clinical psychology Internal medicine Ketamine Law Medicine MEDLINE Meta-analysis Political science Psychiatry Psychology Systematic review Traumatic stress

Substances

Ketamine

Conditions & symptoms

Depression PTSD Sadness or low mood