The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence

Summary & key facts

This paper reviews the medical evidence on using ketamine to treat posttraumatic stress disorder, or PTSD. The authors looked at many kinds of studies, from individual case reports to controlled trials. They say ketamine—an drug that blocks a brain receptor called NMDA and is already used for major depression—shows promising signs of being safe, fast-acting, and helpful for some people with PTSD. But the studies are very different from each other, and the evidence is not yet strong or consistent enough to call it a proven treatment. The authors say more careful research is needed to know who benefits, the best dose and how long effects last.

Key facts:

• PTSD has few good drug treatments and talk therapies are hard to access for many people, so doctors sometimes try off-label medicines for long-standing PTSD.
• Ketamine works by blocking a brain receptor called NMDA and is already approved for major depression because it can lift mood quickly in many people.
• The review combined evidence from many kinds of reports, including individual case reports, chart reviews, open-label studies, and randomized trials.
• Across studies, results were mixed but showed encouraging signs that ketamine can be safe, reduce PTSD symptoms, and have effects that last beyond a single dose for some people.
• The research so far is very varied in who was treated and how ketamine was given, so we do not yet know the best dose, schedule, or which patients are most likely to benefit.

Abstract

Posttraumatic stress disorder (PTSD) is a devastating condition, for which there are few pharmacological agents, often with a delayed onset of action and poor efficacy. Trauma-focused psychotherapies are further limited by few trained providers and low patient engagement. This frequently results in disease chronicity as well as psychiatric and medical comorbidity, with considerable negative impact on quality of life. As such, off-label interventions are commonly used for PTSD, particularly in chronic refractory cases. Ketamine, an N -methyl-D-aspartate (NDMA) receptor antagonist, has recently been indicated for major depression, exhibiting rapid and robust antidepressant effects. It also shows transdiagnostic potential for an array of psychiatric disorders. Here, we synthesize clinical evidence on ketamine in PTSD, spanning case reports, chart reviews, open-label studies, and randomized trials. Overall, there is high heterogeneity in clinical presentation and pharmacological approach, yet encouraging signals of therapeutic safety, efficacy, and durability. Avenues for future research are discussed.

Topics

Anesthesia and Neurotoxicity Research Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Antidepressant Anxiety Clinical psychology Clinical trial Comorbidity Depression (economics) Dissociative Economics Internal medicine Ketamine Macroeconomics Medicine Posttraumatic stress Psychiatry Psychological intervention Psychology Psychotherapist Quality of life (healthcare)

Substances

Ketamine

Conditions & symptoms

Anxiety Depression PTSD Anxiety or worry Feeling disconnected from others Poor sleep Sadness or low mood