The drug ketamine can reduce the symptoms of post-traumatic stress disorder, or PTSD, and symptoms of depression in patients as early as a day after injection. That is the important thing finding of my team’s latest meta-analysis, just published within the journal Annals of Pharmacotherapy.
Ketamine is an anesthetic that is usually used as a substance of abuse but is increasingly being explored as a treatment for a variety of mental health conditions.
We analyzed six randomized controlled trials representing 259 patients with moderate to severe PTSD. In all trials, about half were injected with ketamine. The rest received either salt water or the drug midazolama benzodiazepine like Xanax that can also be used as an anesthetic agent.
Patients receiving ketamine saw their PTSD symptoms reduced by about 25% each at sooner or later and one week after therapy. But if patients received repeated injections over 4 weeksPTSD symptoms declined by only 12%. Reduction of depression symptoms were more modest but still significant.
In most of those trials, patients only received a single shot; in the opposite two, they got an injection at the identical dose six or more times over two to 4 weeks. The advantages after the primary injection were similar across studies, however it’s unclear how well additional doses of ketamine over time maintain these advantages.
Overall, the advantages of even a single ketamine injection occur rapidly, but are modest in magnitude. The best regimen to keep up these advantages by reinjecting ketamine has not been determined.
Why it matters
PTSD, a debilitating mental health disorderoccurs when past trauma causes flashbacks, nightmares, depressed mood, anxiety and avoidance of activities that might trigger traumatic memories. Patients with PTSD are twice as more likely to attempt suicide than the overall population.
About 13 million Americans have PTSD in a given yr, which translates to just about 5% of the adult population. PTSD is attributable to experiencing or witnessing a traumatic event. Many combat veterans have the disorder, as do survivors of physical assault, natural disasters, child abuse and sexual abuse. Those with moderate to severe disease cases lose a mean of about three and a half days of labor monthly because of triggered symptoms or treatment for the illness.
Trauma-focused psychotherapy – techniques that help patients recall, process and respond to traumatic memories – is the treatment of alternative for PTSD, however it can take several weeks to see advantagesand never all patients respond.
For these people, antidepressants corresponding to paroxetine, sertraline and venlafaxine are beneficial as alternatives, or as an addition to psychotherapy.
But like psychotherapy, these drugs may not work for some time – about five to eight weeks – unlike ketamine, which seems to start working almost immediately. That said, the reduction in PTSD and depression symptoms over time following ketamine injection is concerning the same as what the standard antidepressants provide once they take effect.
Because some individuals with severe PTSD could also be experiencing suicidal thoughts, time is of the essence; they simply may not find a way to attend for traditional options to start working. Ketamine is perhaps an efficient bridge to instantly reduce patients’ symptoms until trauma-focused psychotherapy and other antidepressants can kick in.
What still isn’t known
The big unknown with using ketamine for PTSD and depressive symptoms is how often the injections are needed. The data simply just isn’t robust enough to find out whether multiple doses maintain the results higher than simply using a single dose.
Ketamine costs around US$800 per injectionso knowing how much to manage each treatment and what number of injections to provide over time is significant.
Importantly, ketamine might be abused. If purchased from unlicensed pharmacies or online storesthe ketamine product just isn’t approved by the Food and Drug Administration. It may not have the proper dose, could have expired or may not even have any ketamine in it. Or, it could contain a substitute drug with a dangerous lively ingredient, just like the synthetic street drug LSD. Such fake products can harm and even kill patients