Repeated Ketamine Administration for Chronic PTSD: A Breakthrough Study

This blog post is based on the clinical study “A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder” published in the American Journal of Psychiatry. You can read the full study here.

The Urgent Need for Effective PTSD Treatments

Posttraumatic stress disorder (PTSD) is a chronic and disabling psychiatric disorder affecting approximately 6% of the U.S. population. Despite its prevalence, current treatments are often limited by significant rates of nonresponse and partial response. Traditional pharmacotherapies, including SSRIs like sertraline and paroxetine, provide relief for only a fraction of patients, underscoring the need for novel treatments.

Exploring Ketamine as a Treatment for PTSD

Ketamine, originally approved by the FDA as an anesthetic in 1970, has shown promise as a rapid-acting antidepressant. This study aimed to evaluate the efficacy of repeated ketamine infusions over two weeks in individuals with chronic PTSD, assessing both overall symptom severity and specific symptom clusters such as intrusion, avoidance, and negative mood.

Study Design and Methodology

This randomized controlled trial, conducted at the Icahn School of Medicine at Mount Sinai, involved 30 participants with chronic PTSD. Participants received six infusions of either ketamine or midazolam (a psychoactive control) over two weeks. The primary outcome was the change in PTSD symptom severity, measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).

Key Findings from the Study

The study found that repeated ketamine infusions resulted in a significant reduction in PTSD symptoms compared to midazolam. Notably, 67% of participants in the ketamine group showed a clinically significant improvement (≥30% reduction in symptoms) at two weeks, compared to only 20% in the midazolam group.

Ketamine was also associated with significant improvements in depressive symptoms, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). These improvements were rapid, with some patients showing marked reductions in symptoms just 24 hours after the first infusion.

Safety and Tolerability

Overall, ketamine infusions were well-tolerated by participants. The most common side effects included transient dissociative symptoms, dizziness, and fatigue, which resolved shortly after the infusion. Importantly, no serious adverse events were reported, and the treatment was deemed safe for use in a controlled medical setting.

Future Directions and Considerations

While the results are promising, further research is needed to evaluate the long-term efficacy and safety of repeated ketamine administration. Future studies should explore maintenance treatments and the potential benefits of combining ketamine with evidence-based psychotherapies for PTSD.

This study represents a significant step forward in understanding the potential of ketamine as a treatment for chronic PTSD, offering hope for individuals who have not found relief with traditional therapies.

Conclusion

Repeated ketamine administration shows promise as a rapid and effective treatment for chronic PTSD. The significant improvements in PTSD and depressive symptoms observed in this study highlight ketamine’s potential as a valuable tool in psychiatric treatment. However, it is crucial to approach this treatment with caution and conduct further research to fully understand its benefits and risks.

Frequently Asked Questions (FAQs)

References:

• Charney DS. A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder. American Journal of Psychiatry. 2020;177(5):421-429. doi:10.1176/appi.ajp.2020.20050596. Read the full study here.