Will it Work? Ketamine for Post-Traumatic Stress Disorder Treatment

woman looks distressed sitting at a table with her head being held up by her hand

Post-Traumatic Stress Disorder Treatment (PTSD)

In recent years, the understanding, and treatment of mental illnesses have drastically improved.  While the symptoms of PTSD have been described since “mankind’s earliest literature,” it was not till 1980 that the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (DSM-III) added it to the list of mental health diagnoses. Before then, PTSD was understood as “soldier’s heart,” “shell shock,” and “war neurosis.”  Although it is most associated with trauma due to the battlefield and war, PTSD can occur in anyone who has experienced a major traumatic event. A considerable portion of people will experience some traumatic event in their lifetime, and up to 10% will develop clinically diagnosed PTSD.

 

PTSD can typically be characterized by three symptoms: 

  1. Hypermnesia is an enhancement of memory for the core traumatic event. This usually occurs in the form of flashbacks or nightmares.
  2. Hyperarousal is when the body kicks into high alert and is characterized by exaggerated startle, hypervigilance, and irritability.
  3. Avoidance and avoidance behaviors, such as avoidance of reminders associated with the trauma.

 

There have been many attempts to help patients cope with PTSD. Currently, the American Psychological Association’s Clinical Practice Guide recognizes practices like cognitive behavioral therapy, cognitive processing therapy, cognitive therapy, and prolonged exposure as recommended treatments. 

 

Ketamine for Treatment of Depression

Recently, there may be a strong new contender in the world of PTSD treatments. Clinically administered ketamine has shown promising results for patients with similar diagnoses of depression and anxiety. Yale Medicine has studied the relationship between ketamine and depression related to PTSD for the last two decades. In several studies, the researchers have found that more than half of the participants showed a significant decrease in depression symptoms after just 24 hours. These were patients who felt no meaningful improvement on other antidepressant medications and were deemed treatment resistant. The findings of this study have also shown that ketamine is useful for PTSD symptoms, may work best when aligned with cognitive behavioral therapy, and may provide rapid benefits that can be sustained with other comprehensive treatment plans. 

 

The National Institute of Mental Health conducted a review on ketamine and depression and found that, in two randomized, placebo-controlled, crossover studies, ketamine significantly improved depressive symptoms compared to placebo. The effects of ketamine were observed within 40 minutes and lasted through three days post-infusion.

 

Ketamine for Treatment of PTSD  

Ketamine is showing similarly promising results for patients with PTSD. Another Yale study reported that intravenous doses of ketamine reduced psychiatric distress in patients with major depressive disorder (MDD) and PTSD. It also noted that ketamine on cognitive function is “not well understood” and reports that while ketamine may cause acute changes in cognition due to its sedative nature, there is no evidence of ketamine-related cognitive dysfunction at 1-day post-administration. 

 

Ketamine in Military Patients with PTSD

A study was conducted using ketamine during anesthesia for surgery in service members who sustained burns while on duty and had experienced PTSD symptoms. The results demonstrated that contrary to their expectations, patients receiving ketamine during surgery had fewer PTSD symptoms than soldiers who received no ketamine. Additionally, the soldiers who were treated with ketamine had larger burns, a higher injury severity score, and underwent more operations, spending more time in the ICU than those who were not treated with ketamine. Yet the ketamine group exhibited a reduction in PTSD symptoms.

 

There have been some mixed results on the universality of ketamine for PTSD. Three studies were conducted on PTSD in USA military personnel who were given ketamine for injuries sustained while on duty. The first reported that around the time of surgery, those that were administered ketamine had a lower PTSD prevalence. Conversely, the other studies found comparable rates of PTSD and PTSD symptoms among ketamine and non-ketamine groups. 

 

Ketamine Treatments at Avesta Ketamine and Wellness

Although there is evidence to support ketamine’s effectiveness, the evidence is still growing, and there is a need to continue to study the effects of ketamine on PTSD. At Avesta Ketamine & Wellness we have had great success in utilizing ketamine to treat patients with chronic pain and mood disorders, including those struggling with PTSD. We strive for the wellness of all our patients and would love to consult with you about our variety of infusion options. To schedule a consultation, you can call the office or book a visit online today. 

 

References:

American Psychological Association. (2020, June). Treatments for PTSD. American Psychological Association.https://www.apa.org/ptsd-guideline/treatments

Chen, J. (2022, March 9). How ketamine drug helps with depression. Yale Medicine.https://www.yalemedicine.org/news/ketamine-depression

 

Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues in Clinical Neuroscience, 2(1), 47–55. https://doi.org/10.31887/DCNS.2000.2.1/macrocqhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181586/

 

Davis, M. T., DellaGiogia, N., Maruff, P., Pietrzak, R. H., & Esterlis, I. (2021). Acute cognitive effects of single-dose intravenous ketamine in major depressive and posttraumatic stress disorder. Translational Psychiatry, 11(1), 205. https://doi.org/10.1038/s41398-021-01327-5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032778/

 

Keeler, J. L., Treasure, J., Juruena, M. F., Kan, C., & Himmerich, H. (2021). Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review. Nutrients, 13(11), 4158. https://doi.org/10.3390/nu13114158  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8625822/

 

Kishimoto, T., Chawla, J. M., Hagi, K., Zarate, C. A., Kane, J. M., Bauer, M., & Correll, C. U. (2016). Single-dose infusion ketamine and non-ketamine N-methyl-d-aspartate receptor antagonists for unipolar and bipolar depression: a meta-analysis of efficacy, safety and time trajectories. Psychological Medicine, 46(7), 1459–1472. https://doi.org/10.1017/S0033291716000064 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116384/

 

Liriano, F., Hatten, C., & Schwartz, T. L. (2019). Ketamine as treatment for post-traumatic stress disorder: a review. Drugs in context, 8, 212305. https://doi.org/10.7573/dic.212305https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457782/

 

Mcghee, L.L.; Maani, C.V; GarZa, T.H.; Gaylord, K.M.; Black, I.H. (2008). The correlation between ketamine and posttraumatic stress disorder in burned service members, The Journal of Trauma: Injury, Infection, and Critical Care. Volume 64 – Issue 2 – p S195-S199 doi: 10.1097/TA.0b013e318160ba1dhttps://journals.lww.com/jtrauma/Abstract/2008/02001/The_Correlation_Between_Ketamine_and_Posttraumatic.29.aspx

Mount Sinai Health System. (2021, January 5). Repeated ketamine infusions reduce symptom severity in individuals with chronic post-traumatic stress disorder. Mount Sinai Health System. https://www.mountsinai.org/about/newsroom/2021/repeated-ketamine-infusions-reduce-symptom-severity-in-individuals-with-chronic-post-traumatic-stress-disorder

PTSD. Avesta Ketamine and Wellness (n.d.) https://www.avestaketaminewellness.com/services/ptsd 

 

Steckler, T., & Risbrough, V. (2012). Pharmacological treatment of PTSD - established and new approaches. Neuropharmacology, 62(2), 617–627. https://doi.org/10.1016/j.neuropharm.2011.06.012https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204327/

 

Walsh, Z., Mollaahmetoglu, O. M., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D. J., & Morgan, C. (2021). Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych open, 8(1), e19. https://doi.org/10.1192/bjo.2021.1061  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8715255/

 

Yavi M, Lee H, Henter ID, Park LT, Zarate CA Jr. Ketamine treatment for depression: a review. Discovery Mental Health. 2022;2(1):9. doi:10.1007/s44192-022-00012-3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010394/

Photo by RODNAE Productions from Pexels: https://www.pexels.com/photo/love-people-woman-girl-6670274/

Author
Dr. Ladan Eshkevari, PhD, CRNA, FAAN Dr. Eshkevari is the lead clinician at Avesta, and is a long time researcher and educator in physiology, biophysics, and anesthesiology. She is passionate about assisting patients with retractable, difficult to treat mood disorders, and relies on the latest research to bring evidence to Avesta's practice to better understand and serve patients.

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