Most people have heard about PTSD these days. It is a condition characterized by nightmares. A condition that frequently occurs secondary to some emotional trauma. However, internal factors also play a role in disease development as people interpret the same situation differently.
The condition is pretty common these days. Latest estimates suggest that about 6% of people are living with PTSD in the US. Further, it appears that the condition is relatively more common in women. Additionally, the condition is more likely to be reported in veterans.(1)
Of course, most people experience some emotional trauma during their lives. However, many people are able to cope and overcome the negative life experiences. However, some individuals struggle to overcome such issues. They find it difficult to forget traumatic experiences, which may result in a significant change in mental health.
Those living with the condition struggle to forget certain traumatic effects. They just keep thinking about those issues. They experience flashbacks, upsetting dreams, and severe emotional distress. Of course, things are not limited to just emotional distress, and the condition can also adversely affect physical health.
Such issues are best managed without medications, and psychotherapy can help. Cognitive behavior therapy can help such individuals avoid specific thoughts, places, activities, and people that might remind them of traumatic events.
A small number of people develop severe issues as they are unable to overcome PTSD, and they need medications. They might feel emotionally numb, have difficulty concentrating, and maintain close relationships. They readily become angry and irritated, have trouble sleeping, and may even engage in destructive behavior like drinking too much.
It is vital to understand that the condition is sometimes pretty severe. Hence, such individuals must be treated using medications.
Why Consider Ketamine for PTSD?
Before we explore how good ketamine is and what is the quality of evidence in favor of its use. Let us first consider the reasons for using ketamine. After all, why even care about using ketamine, as there are many other medications?
Perhaps the first reason to consider ketamine is that there are still very few treatment options for the condition. Hence, there are only three US FDA-approved drugs. Those are two SSRIs (selective serotonin reuptake inhibitors), sertraline and paroxetine, and one SNRI (serotonin-norepinephrine reuptake inhibitor), venlafaxine.(2)
It means that even doctors do not have many options. Even these three approved drugs are not very effective and may help only in a small number of cases. Hence, this is perhaps the second reason to consider ketamine. It is difficult to believe that despite some excellent results, ketamine is still awaiting US FDA approval for such use. However, this does not mean that using ketamine is not allowed for managing PTSD. Doctors are still allowed to use ketamine for PTSD.
Doctors often consider some other drugs, too, like various antidepressants, antipsychotics, antiseizure drugs, and drugs for treating migraine. However, studies show these medications have no proven benefit and might cause more harm.(2)
As PTSD is an anxiety spectrum disorder, doctors might think of using benzodiazepines. However, again, studies show that these approaches are not only not helpful but also cause more harm than good.(2)
Due to fewer treatment options, doctors commonly prescribe unproven drug therapies that might cause more harm than good. Hence, patients who did not benefit from US FDA-approved oral drugs must consider ketamine IV therapy. Moreover, such a therapy has a faster mode of action with prolonged benefits.
Studies show that even by using psychotherapy and oral drugs, only 30% make a complete recovery, and 40% benefit a bit. It means that one-third of patients do not report any benefit. This underlines the importance of finding novel treatment approaches.(3)
Those considering ketamine for PTSD must understand that unmanaged PTSD can have significant harm. It may cause severe mood disorders, anxiety and panic, neurological issues, and more. Untreated PTSD increases the risk of improper behavior and substance abuse disorder.
Ketamine for Overcoming Nightmares
It is not uncommon in medicine to repurpose the drugs. This has some benefits, like the drug already having a proven safety profile. Moreover, exploring existing drugs for managing health conditions means that much is already known about that specific drug.
Ketamine has been around for more than half a century. It is approved as an anesthetic and analgesic and thus commonly used in clinics during surgical procedures.
It is also known to have mind-altering properties. That is why it is also a substance of abuse.
So, why not explore its mind-altering ability in clinical practice? This is what researchers have been doing in the last few years. They have been testing ketamine in a range of mental health conditions, and every time they try this drug, they are amazed at how well it works. It works faster and better than many other medications, and sometimes, it has a long-lasting benefit for mental health conditions.
It is known to block the so-called NMDA brain receptors. Researchers first tested it in animals to overcome PTSD, and they found it to be effective. In the last few years, they have been testing it in humans with encouraging effects.(4)
There is a reason why researchers are recommending ketamine therapy for PTSD and other mental health issues. They are amazed that, unlike oral drugs that take weeks to start working, ketamine works pretty fast. Doctors use slow IV ketamine infusion, and many patients experience benefits within hours, reporting reduced stress, fear, anxiety, and a good night’s sleep.
There are many clinical studies regarding ketamine use in PTSD. However, before going for ketamine therapy, there are a few things to know. Studies show that ketamine is not good for acute PTSD episodes. Thus, soldiers on the battlefield cannot benefit from it. Not only that, ketamine can even make acute PTSD episodes worse. However, on the contrary, it is quite good for chronic PTSD.(5)
There are a few ways to interpret these findings. Firstly, do not use ketamine tablets or illicit drugs containing ketamine to manage PTSD, as that is not going to help and make things worse. Similarly, ketamine is not for preventing or managing early PTSD issues. Ketamine is better for those with established PTSD. It is a better choice for those for whom other treatments have failed. It is better to explore ketamine in those instances when a person has been living with the condition for a few months or even years, and nothing helped. But, then, this is a really good news that ketamine is better for chronic and resistant cases.
For most people, a single ketamine IV therapy session could be life-transforming, especially if one has been experiencing nightmares for years. However, not everyone may benefit sufficiently from a single treatment session. New studies show that ketamine is also safe and good for repeated treatment sessions, and this may result in even better symptom control in chronic PTSD.(6)
Since patients need just one ketamine infusion a week, it is good for use along with other medications. However, it is vital to understand that ketamine may interact with some of the drugs. Therefore, those looking to use ketamine IV therapy must share their treatment information with the therapist.
PTSD is also about changing thinking patterns. Although ketamine is only suitable for chronic PTSD, but then changing or subduing long-established fears is quite challenging. Hence, it is better to combine non-pharmacological means with drug treatment.
Therefore, it is good to combine ketamine IV therapy with psychotherapy, like cognitive behavior therapy. Generally, it is better to consider a psychotherapy session post-ketamine infusion when the person is more receptive to various suggestions.
In one of the studies, researchers analyzed 19 studies with more than 1000 participants, and they found that there is strong evidence that psychotherapy combined with ketamine can be a really useful tool for managing PTSD. Moreover, it appears that combining ketamine with psychotherapy is suitable for treatment-resistant cases. However, researchers noticed treatment protocols varied significantly among various studies. Thus, there is definitely a need to define the treatment protocol.(7)
So, we can say that ketamine is good for managing PTSD. However, more research is needed to establish better treatment protocols. It is also essential to develop a better understanding of how to combine ketamine therapy with various treatment options. Further, there is a need for more studies to learn how to use this therapy effectively in various age groups.
How Could Ketamine Help With PTSD?
This is still poorly understood. Of course, researchers know much about ketamine. They know that it is a potent blocker of so-called NMDA receptors in the brain. However, that is not all. It can also influence serotonin, dopamine, acetylcholine, and other receptors. It may also alter the concentration of various neurotransmitters. This is just one of the ways in which ketamine may alter emotional responses and help modify memories and emotions.
Of course, science still has to learn the exact mechanism of its action. However, it is vital to understand that neurobiology is one of the last frontiers. Decoding the working mechanism of the brain is very challenging, and science still has to learn much.
Science knows that memories are formed due to synaptic connections. Neurons connect with each other in specific ways to create memories. It also means that substances promoting brain rewiring can help with brain disorders. Researchers have a firm reason to believe that ketamine helps alter connections between neurons and thus alters specific memories and brain responses.
Moreover, there are a few things that researchers are trying hard to understand. First are the findings that ketamine works pretty quickly, unlike other drugs used to treat PTSD. Secondly, it continues to benefit long after ketamine cannot be found in the blood. All this means that ketamine has some immediate impact on the working of neurons. However, it also has some long-term effects on neuronal plasticity, thus resulting in long-term benefits for brain health.
Further, one must note that, quite like many other brain disorders, science does not clearly understand the anatomical basis of PTSD. This means that they do not know what brain changes cause PTSD. Nonetheless, progress is being made as brain scans are improving, allowing researchers to visualize various brain parts better and even minute cellular level changes.
Hence, in recent years, researchers have started describing PTSD as rather a “synaptic disconnection syndrome.” This means that emotional shock in some individuals leads to a breakdown in certain brain connections. So, PTSD causes a kind of destructive brain changes that are challenging to reverse. Further, studies suggest that ketamine IV therapy may help restore these broken connections, thus helping overcome PTSD.(8)
Some early studies have confirmed that ketamine therapy really causes changes in brain connections. It causes these changes in specific brain parts and improves connectivity between various brain parts. Such changes are visible as increased activity in specific brain areas after multiple ketamine IV therapies. Moreover, researchers noticed that such changes are not seen with other anesthetic drugs like midazolam. These changes are especially seen in brain areas associated with emotions, like amygdala.(9)
How Would Doctors Carry Out Ketamine Treatment?
It is worth understanding that doctors use IV ketamine therapy for managing PTSD. They do not use tablets. Usually, they would give a slow IV infusion once a week. In most cases, multiple therapies would be needed to alter brain response and manage chronic PTSD.
Before beginning the infusion, vital signs such as blood pressure, heart rate, and oxygen saturation are monitored to ensure the patient’s safety throughout the procedure.
The ketamine infusion is then initiated at a carefully controlled dosage under the supervision of medical staff. The infusion may last anywhere from 40 minutes to a few hours, during which the patient remains relaxed and reclined in a supportive environment.
Throughout the session, the patient may experience a range of sensations, including a sense of dissociation from their surroundings, altered perception of time, and profound introspection. These effects are typically transient and are closely monitored by healthcare providers to ensure the patient’s comfort and safety.
Some patients do report a few unpleasant effects, like nausea and vomiting, but these effects do not last for more than a couple of hours. This is why patients have to stay in a clinic for a few hours after the therapy. Here, it is also worth noticing that side effects are generally milder with each reported IV session as the body gets used to ketamine.
The Bottom Line
PTSD is quite a common anxiety spectrum disorder characterized by fear, nightmares, self-destructive thoughts, and more. It is not a rare condition and affects millions of adults. Although the condition is pretty common, it is challenging to treat. There are just three oral drugs approved to manage the condition. These drugs are able to help just in a small number of cases. When these drugs do not help, doctors might consider various unapproved treatments. Studies show that many of these drugs, like anxiolytics, antidepressants, and antiseizure drugs, cause more harm than good.
As oral drugs fail in so many cases, there is little surprise that just about one-third of all those diagnosed with the condition are able to overcome it. The rest of those continue to experience PTSD-related distress for years to come, experiencing sweating, nightmares, engaging in destructive behavior, and more.
However, now, a new kind of treatment provides much hope. It appears that ketamine IV therapy is quite good for PTSD. Of course, it is not a perfect treatment and has its downsides. Studies show that it is not really good for managing acute PTSD. However, it is incredibly good for managing chronic PTSD.
Another good thing about this therapy is that IV ketamine can also help in resistant cases. This means that it may be especially good for those who did not benefit from other medical treatments.
Further, patients must keep in mind that ketamine IV therapy works even better when combined with lifestyle changes and psychotherapy. It appears that ketamine makes people more receptive to instructions, and it also promotes brain rewiring. All this makes psychotherapy more effective.
Ketamine can be used in the short- or long-term as part of a broader treatment effort. Usually, once a week of ketamine slow infusion is enough. Since the dosing is once a week, it means good patient compliance and fewer chances of side effects.
Although ketamine may cause some acute side effects like dissociative symptoms, confusion, nausea, and some other issues, these side effects do not last long. However, ketamine is not likely to cause severe organ toxicity, making it a good treatment choice in the long run.
To sum up, PTSD must be considered in all patients living with the condition for a long. Moreover, the therapy is even better for those who did not respond to other treatments. Although ketamine is a controlled substance, it is safe when used by clinicians. More than 50 years of safety data confirms that it poses no severe health risks. For those living with PTSD, even a single ketamine IV therapy session may turn out to be a life-changing event, helping get rid of long-standing issues.
References
- VA.gov | Veterans Affairs [Internet]. [cited 2024 Mar 2]. Available from: https://www.ptsd.va.gov/understand/common/common_adults.asp
- Alexander W. Pharmacotherapy for Post-traumatic Stress Disorder In Combat Veterans. P T. 2012 Jan;37(1):32–8.
- Mann SK, Marwaha R. Posttraumatic Stress Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Mar 2]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559129/
- Feder A, Rutter SB, Schiller D, Charney DS. Chapter Nine – The emergence of ketamine as a novel treatment for posttraumatic stress disorder. In: Duman RS, Krystal JH, editors. Advances in Pharmacology [Internet]. Academic Press; 2020 [cited 2024 Mar 2]. p. 261–86. (Rapid Acting Antidepressants; vol. 89). Available from: https://www.sciencedirect.com/science/article/pii/S1054358920300405
- Du R, Han R, Niu K, Xu J, Zhao Z, Lu G, et al. The Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis. Frontiers in Psychiatry [Internet]. 2022 [cited 2024 Mar 2];13. Available from: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.813103
- Feder A, Costi S, Rutter SB, Collins AB, Govindarajulu U, Jha MK, et al. A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder. AJP. 2021 Feb;178(2):193–202.
- Kew BM, Porter RJ, Douglas KM, Glue P, Mentzel CL, Beaglehole B. Ketamine and psychotherapy for the treatment of psychiatric disorders: systematic review. BJPsych Open. 2023 May;9(3):e79.
- Krystal JH, Abdallah CG, Averill LA, Kelmendi B, Harpaz-Rotem I, Sanacora G, et al. Synaptic Loss and the Pathophysiology of PTSD: Implications for Ketamine as a Prototype Novel Therapeutic. Curr Psychiatry Rep. 2017 Aug 26;19(10):74.
- Norbury A, Rutter SB, Collins AB, Costi S, Jha MK, Horn SR, et al. Neuroimaging correlates and predictors of response to repeated-dose intravenous ketamine in PTSD: preliminary evidence. Neuropsychopharmacol. 2021 Dec;46(13):2266–77.
