Anesthetic Ketamine Alleviates PTSD Symptoms

the Psychiatry Advisor take:

Few medications have shown promise in the treatment of posttraumatic stress disorder (PTSD), but the anesthetic ketamine may have potential to do so, according to researchers.

Adriana Feder, MD, and colleagues at the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, found that giving a single intravenous dose of ketamine led to a significant and rapid reduction in PTSD symptom severity 24 hours after infusion (mean difference in Impact of Event Scale–Revised score, 12.7; 95% CI: 2.5-22.8; P=0.02).

In the double-blind, crossover trial, 41 patients with chronic PTSD were randomized to get either ketamine hydrochloride (0.5 mg/kg) or an active placebo control, midazolam (0.045 mg/kg). The primary outcome measure was change in PTSD symptom severity, measured using the Impact of Event Scale–Revised. Results were published in JAMA Psychiatry.

Greater reduction of PTSD symptoms following treatment with ketamine was evident in both crossover and first-period analyses, and remained significant after adjusting for baseline and 24-hour depressive symptom severity. Ketamine was also associated with reduction in comorbid depressive symptoms and with improvement in overall clinical presentation. The drug was also generally well tolerated.

"This study provides the first evidence for rapid reduction in symptom severity following ketamine infusion in patients with chronic PTSD,” Feder and colleagues concluded. "If replicated, these findings may lead to novel approaches to the pharmacologic treatment of patients with this disabling condition."

Understanding biological underpinnings of anxiety, phobias and PTSD
Anesthetic Ketamine Alleviates PTSD Symptoms

A single dose of ketamine given in an intravenous (IV) infusion resulted in the rapid reduction of symptoms of posttraumatic stress disorder (PTSD) in a proof-of-concept, randomized, double-blind study of 41 patients with chronic PTSD.

For each procedure day, patients were assigned to receive a single IV infusion of ketamine hydrochloride or midazolam, administered over 40 minutes. The order of infusions was randomly assigned, and administrations were made 2 weeks apart. Midazolam was chosen as the active placebo because its pharmacokinetic parameters and nonspecific behavioral effects are similar to those of ketamine. 

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