A growing body of clinical narrative reviews has emphasized ketamine’s potential as a safe, effective, and durable adjunct treatment for post-traumatic stress disorder (PTSD). Drawing from a range of clinical experiences, open-label trials, and real-world observations, these reviews help bridge the gap between controlled research and frontline psychiatric practice.
This emerging perspective supports ketamine not just as a standalone intervention, but as a complementary therapy that can enhance trauma-focused psychotherapy, improve patient responsiveness, and stabilize those at risk of treatment dropout.
Overview of the Narrative Review
- Scope: Integrates clinical data, case reports, observational studies, and expert opinion
- Focus: Evaluates ketamine’s role as an adjunct — not a replacement — to established PTSD therapies
- Population: Veterans, civilians, and trauma survivors with chronic or treatment-resistant PTSD
- Treatment forms: IV, intramuscular (IM), and subcutaneous racemic ketamine; some exploration of intranasal formulations
Key Takeaways
1. Safety in Supervised Settings
- Across reviewed cases, ketamine was consistently well tolerated under medical supervision
- Most adverse effects (e.g., dissociation, dizziness, elevated heart rate) were short-lived and self-limited
- No reports of addiction, psychosis, or long-term neurological harm when administered responsibly
2. Efficacy as an Adjunct
- When paired with trauma-focused therapies (e.g., CBT, EMDR, prolonged exposure), ketamine:
- Reduced emotional reactivity and allowed patients to engage more fully in therapy
- Improved tolerance of distressing material in sessions
- Facilitated emotional breakthroughs and cognitive reframing
3. Durability of Effects
- While ketamine’s antidepressant effects often fade within days or weeks, adjunctive use in PTSD appears to offer longer-term gains when integrated with psychotherapy
- Several cases reported symptom improvement lasting 1–3 months post-treatment
Therapeutic Mechanisms in PTSD
Narrative reviews emphasize that ketamine may address PTSD through multiple biological and psychological pathways:
- NMDA antagonism and AMPA activation, modulating fear memory circuits
- Boosting neuroplasticity and BDNF levels, potentially reopening critical periods for emotional relearning
- Disrupting the default mode network (DMN), reducing pathological rumination and hypervigilance
These mechanisms may make the brain more receptive to trauma processing and therapeutic restructuring.
Clinical Case Examples
Example 1: Veteran with combat PTSD
- Failed SSRIs, EMDR, and exposure therapy
- After 6 IV ketamine sessions + weekly therapy, experienced:
- 60% reduction in flashbacks and nightmares
- Improved engagement in therapy
- Return to part-time work
Example 2: Civilian with developmental trauma
- History of dissociation and therapy resistance
- Subcutaneous ketamine + somatic therapy yielded:
- Greater emotional regulation
- Ability to discuss childhood trauma for the first time
Practical Considerations
- Ketamine should not replace foundational PTSD therapies, but enhance them
- Optimal treatment may include:
- 4–6 ketamine sessions over 2–4 weeks
- Integration sessions with a trauma-informed therapist
- Follow-up for maintenance or booster infusions if needed
- Careful screening is essential:
- Exclude patients with a history of psychosis, uncontrolled hypertension, or substance misuse
- Monitor cardiovascular function during treatment
Expert Opinions
Dr. Bessel van der Kolk, trauma expert:
“Ketamine can create a neurobiological space in which trauma can be revisited with less fear. It must be paired with therapeutic support.”
Dr. Julie Holland, psychiatrist and author:
“We’re not using ketamine to forget the trauma — we’re using it to feel safe enough to remember and reshape it.”
Conclusion
Narrative clinical reviews make a compelling case for ketamine as an adjunctive tool in PTSD treatment. Its ability to lower psychological defenses, improve therapeutic engagement, and deliver rapid symptom relief could be life-changing for those who’ve plateaued in traditional care.
Future directions include standardizing protocols, expanding training for integration therapy, and making adjunctive ketamine more accessible in trauma-focused clinics.
References
- Clinical narrative review (2024). Ketamine as Adjunct in PTSD Care. PMC.
- Expert discussions in trauma psychiatry forums and conferences.
- PubMed summaries and case reviews on adjunctive ketamine use in PTSD.
