Ketamine for PTSD: Expectations and Considerations

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Posttraumatic stress disorder (PTSD) affects the lives of many people globally. The overall lifetime prevalence of PTSD is 6.8%, and an estimated 3.6% of adults in the United States currently struggle with the condition.

Currently, most patients with PTSD are treated with antidepressant medications and cognitive-behavioral therapy. In many instances, though, standard treatments will fail to help alleviate PTSD symptoms, leading to many new approaches to treating this condition, including ketamine.

Characteristics of PTSD

Symptoms of PTSD fall into four categories.

  • Intrusion: This includes intrusive thoughts, including involuntary memories, distressing dreams, or flashbacks of traumatic events. 
  • Avoidance: Individuals with PTSD may avoid people, places, objects, and situations that trigger distressing memories. This avoidance allows individuals to evade thinking or to talk about what happened.
  • Alterations in cognition and mood: Those with PTSD may demonstrate an inability to remember the important elements of a traumatic event, experience distorted thoughts about the event, blame oneself, exhibit less interest in activities previously enjoyed, feel detached from others, or be unable to experience positive emotions.
  • Alterations in arousal or reactivity: This may include being irritable or angry, behaving recklessly, being self-destructive, easily startled, or having issues with sleep and concentration.

Standard treatment for those with PTSD is selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs). Benzodiazepines, mood stabilizers, and antipsychotics may be prescribed ‘off-label.’ However, patients with PTSD rarely achieve complete remission with standard treatments.

Ketamine as a Treatment for PTSD

Ketamine treatment has shown great promise in addressing the symptoms of chronic PTSD patients. Repeated ketamine treatments have been shown to significantly reduce the severity of symptoms in individuals with post-traumatic stress disorder. This finding comes from a study conducted by researchers from the Icahn School of Medicine at Mount Sinai.

This clinical trial used the Clinician-Administered PTSD Scale for DSM-5 and the Montgomery-Asberg Depression Rating Scale (MADRS), standard rating scales for assessing PTSD and depression. These scales were used to assess patients who received six infusions of ketamine administered three times per week over a two-week period.

Compared to a control group receiving midazolam, more participants in the ketamine group attained at least 30% or more reduction in symptoms while receiving ketamine treatments. Ketamine infusions were associated with marked improvement in three of the four PTSD symptom groups – intrusions, avoidance, and negative alterations in cognition and mood.

Unlike SSRIs, ketamine works on the glutamatergic system via the blockade of the N-Methyl-D-Aspartate (NMDA) receptor. Ketamine may have multiple ways to improve PTSD symptoms and resistant depression, including its dissociative properties.

Therefore, it has attracted much interest as a form of treatment for those with PTSD, mainly if comorbid depressive symptoms are also present. In addition, a chemical derivative of ketamine, called esketamine, was approved by the FDA in 2019 for depression treatment. It is also used off-label for PTSD treatment.

What to Expect with Ketamine for PTSD

Patients may react to ketamine administration in many ways. Therefore, it is a unique experience for each patient, and its effects often depend upon several variables, including the patient’s metabolism, dosage, and previous experiences with ketamine.

While the experience is unique, many patients report the following feelings:

  • Numbing of the extremities.
  • Difficulty with speaking or forming words.
  • Potential for different emotions to take hold.
  • Entering a state of dissociation from the body.
  • Experiencing a stillness of the mind, often accompanied by feelings of relaxation, happiness, or euphoria.
  • Different experiences of the senses, including the ‘slowing’ of time and the ‘seeing’ of colors and shapes.
  • The ability to relive past experiences, but with different outcomes.

When starting ketamine treatment, clinicians often begin with a very low dose to understand how the patient will react. Patients are carefully monitored during this time. The dosage may be increased during subsequent visits to achieve the full benefit of ketamine treatment. Patients often feel sleepy or disoriented when receiving treatment, although they remain alert enough to communicate with staff and can leave the session unassisted.

Ketamine is often metabolized within two hours, and its effects wear off relatively quickly, but its impact on PTSD symptoms can last far longer. Moreover, many patients benefit from the alleviation of PTSD symptoms without the risks that come with SSRI treatments. Side effects of this treatment are relatively rare and generally mild. These side effects can include slight elevation iin blood pressure, nausea or mild, non-threatening hallucinations.

PTSD is a severe mental health disorder that often negatively impacts one’s quality of life. Unfortunately, conventional treatments are not always efficacious. Ketamine offers a treatment alternative with fewer risks and side effects that can also alleviate the symptoms of PTSD and help many individuals suffering from this condition.

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