Ketamine for Treatment of Posttraumatic Stress Disorder: State of the Field
Abstract
Psychotherapeutic Treatments for PTSD
Pharmacological Treatments for PTSD
Animal Models Implicate Glutamatergic N-Methyl-D-Aspartate (NMDA) Receptor Activity in Fear and Depression
Fear Acquisition and Extinction in Animals Linked to Glutamatergic NMDA Receptor Activity
Ketamine Emerges as a Treatment for Depression and Possibly for PTSD
Systemic Administration of NMDA Antagonists, Including Ketamine, Improves Depressive- and PTSD-Like Symptoms in Rodents
Ketamine Emerges as a Rapid-Acting Antidepressant and Novel Treatment for Depression
Studies Examining Effects of Peritraumatic Ketamine Administration on Development of PTSD
Ketamine as a Treatment for Chronic PTSD
First RCTs of Repeated Ketamine for Chronic PTSD
Larger RCT of Repeated Ketamine for Antidepressant-Resistant PTSD of Veterans and Active-Duty Service Members
Ketamine Studies Among Individuals With Comorbid PTSD
Framework for Understanding How Ketamine May Improve PTSD
Publication | Diagnosis | Population | Sex, female (%) | N | Ketamine intervention | Effect on PTSD symptoms |
---|---|---|---|---|---|---|
Feder et al., 2014 (43) | Chronic PTSD | Community | 46 | 41 | Single intravenous (IV) infusion of ketamine hydrochloride (.5 mg/kg) vs. single IV infusion of midazolam (.045 mg/kg) | Ketamine superior to midazolam |
Feder et al., 2021 (44) | Chronic PTSD | Community | 77 | 30 | Repeated IV infusions of ketamine hydrochloride (.5 mg/kg) vs. midazolam (.045 mg/kg), 3 times a week for 2 weeks (total six infusions) | Ketamine superior to midazolam |
Abdallah et al., 2022 (45) | Treatment-resistant chronic PTSD | Veterans and active-duty service members | 23 | 158 | Repeated IV infusions of standard-dose ketamine (.5 mg/kg) vs. low-dose ketamine (.2 mg/kg) vs. placebo (saline), twice weekly for 4 weeks (total eight infusions) | No significant between-group differences |
Next Steps: Combining Ketamine and Psychotherapy for Chronic PTSD
Publication | Diagnosis | Population | Sex, female (%) | N | Ketamine intervention | Therapy intervention | Study design | Effect on PTSD symptoms |
---|---|---|---|---|---|---|---|---|
Shiroma et al., 2020 (67) | Chronic PTSD | Veterans | 30 | 10 | Repeated IV infusions of ketamine (.5 mg/kg) once a week for 3 weeks | PE weekly for up to 10 weeks | Open label clinical trial | Improved symptoms |
Pradhan et al., 2018 (64) | Treatment-resistant chronic PTSD | Community | 60 | 20 | Single IV infusion of ketamine (.5 mg/kg) vs. single IV infusion of normal saline | TIMBER psychotherapy, 12 sessions | Pilot randomized clinical trial | No significant between-group difference at 24 hours. Longer duration of improvement in the ketamine group |
Keizer et al., 2020 (63) | Chronic pain and PTSD | Veterans | 27 | 11 | Continuous IV infusion of ketamine starting at 2 μg/kg/min, increased to a final dose of 11–15 μg/kg/min, lasting approximately 96 h at this final dose | Bedside psychotherapy for 90 minutes | Case series, patients receiving ketamine infusion for chronic pain | Improved symptoms |
Insights From Studies Exploring the Role of Ketamine in PTSD
Conclusions
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