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Ketamine infusion reduced chronic PTSD symptom severity

Chronic posttraumatic stress disorder symptom severity was rapidly reduced after ketamine infusion, according to recent study findings published in JAMA Psychiatry.

Adriana Feder, MD, of the department of psychiatry at Icahn School of Medicine at Mount Sinai, and colleagues evaluated 41 adults aged 18 to 55 years with a diagnosis of chronic PTSD to determine efficacy and safety of a single IV dose of ketamine for the treatment of PTSD symptoms. Patients were randomly assigned to ketamine or midazolam for their first infusion and then the opposite as a second.

Within 24 hours, ketamine improved the Impact of Event Scale-Revised (IES-R) compared with midazolam (P=.02). Symptoms remained significantly reduced among seven patients assigned ketamine first compared with one patient assigned midazolam first.

Clinician-administered PTSD Scale (CAPS) did not differ significantly between treatment 7 days after infusion (P=.2).

Montgomery-Asberg Depression Rating Scale (MADRS) in the 24 hours after treatment showed ketamine led to significantly better improvement compared with midazolam.

After ketamine, dissociative symptoms were short-lived, peaked at 40 minutes, and resolved 120 minutes after the infusion. Significant psychotic or manic symptoms were not observed.

In the first 24 hours after infusion, the most frequently reported adverse events were blurred vision (ketamine, 36% vs. midazolam, 19%), dry mouth (21% vs. 16%), restlessness (23% vs. 10%), fatigue (21% vs. 23%), nausea/vomiting (21% vs. 3%), poor coordination (15% vs. 3%) and headache (13% vs. 13%).

“Our results provide the first evidence that a single dose of IV ketamine was associated with rapid reduction of core PTSD symptoms and reduction in comorbid depressive symptoms in patients with chronic PTSD and that it was generally well tolerated without clinically significant persistent dissociative symptoms,” the researchers wrote. “Future studies are needed for replication, and they should examine the efficacy and safety of ketamine administration beyond a single infusion for patient with chronic PTSD, explore the use of ketamine anesthesia to prevent the emergence of PTSD symptoms in surgical patients with a history of trauma, investigate the mechanisms of ketamine action, and identifying pretreatment predictors of response to this intervention.”

Disclosure: See the study for a full list of researchers’ financial disclosures.