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

Summary & key facts

This paper looked at existing clinical evidence about using ketamine to treat posttraumatic stress disorder, by bringing together case reports, chart reviews, open-label studies, and randomized trials. The studies were very varied in who was treated and how ketamine was given, but the overall message was cautiously hopeful: many reports show ketamine can be given safely and can reduce symptoms for some people, sometimes with effects that last. The authors say the evidence is promising but not yet strong enough to be sure who will benefit most, what dose to use, or how long the benefits last, so more careful research is needed.

Key facts:

• PTSD has few reliable drug treatments, and trauma-focused psychotherapies are limited by the small number of trained therapists and low patient engagement, which often leads to long-lasting illness and other health problems.
• The review collected evidence from many kinds of clinical reports, including single case reports, chart reviews, open-label studies (where everyone knows they got the drug), and randomized trials (which compare ketamine against another treatment).
• Ketamine is already used for major depression and can work quickly. This review found encouraging signs that ketamine might also reduce PTSD symptoms for some people and that effects can sometimes last beyond the immediate treatment.
• The studies the authors looked at were very heterogeneous, meaning the patients, the way ketamine was given, and the result measures differed a lot across studies. That makes it hard to draw firm conclusions.
• Because of the mixed methods and limited data, the authors call for more high-quality research to find the best doses, who is most likely to benefit, and how long any benefits last.

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