The emergence of ketamine as a novel treatment for posttraumatic stress disorder

Jul 4, 2020Advances in pharmacology (San Diego, Calif.)

Ketamine as a new treatment for posttraumatic stress disorder

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Abstract

The first proof-of-concept randomized clinical trial indicates that ketamine may have rapid effects on chronic PTSD symptoms.

Ketamine is a noncompetitive NMDA receptor antagonist previously used for anesthesia and pain relief.
Emerging evidence suggests ketamine could reduce symptoms of chronic PTSD after a single intravenous dose.
Ongoing randomized clinical trials are exploring the effects of repeated ketamine infusions on maintaining symptom improvement in PTSD patients.
Mixed results have been observed regarding ketamine's effectiveness when administered shortly after traumatic events.
Animal studies suggest ketamine may influence memory processes related to fear and stress response.
Further research is needed to assess ketamine's potential to enhance the effectiveness of psychotherapy for chronic PTSD.

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A serious lack of effective pharmacotherapeutic interventions for posttraumatic stress disorder (PTSD) raises the urgent need for the development of novel treatments. Ketamine-a noncompetitive glutamate N-methyl-d-aspartate (NMDA) receptor antagonist in use for decades as an anesthetic and analgesic agent-has more recently been demonstrated to have rapid-onset antidepressant effects in patients with treatment-resistant depression (TRD). In the present review of ketamine as an emerging novel pharmacotherapeutic intervention for chronic PTSD, we discuss findings from the first proof-of-concept, randomized clinical trial (RCT) of single-dose intravenous ketamine in patients with chronic PTSD, as well as open-label studies and current practice. We introduce ongoing RCTs investigating the efficacy of repeated ketamine infusions in rapidly reducing symptoms and maintaining improvement in samples of individuals with PTSD stemming from civilian and military traumas. Additionally, we discuss mixed findings from published reports on ketamine administration in the acute aftermath of trauma. Studies in animal models of chronic stress have investigated molecular mechanisms underlying ketamine's effects, generating a shift in the conceptualization of PTSD as a disorder of impaired neural connectivity. We review animal studies examining the potential of ketamine to modify the expression of fear by altering memory reconsolidation or enhancing fear extinction, as well as others investigating ketamine administration prophylactically prior to stress exposure. We introduce the need for additional study in humans to evaluate whether ketamine might enhance the efficacy of psychotherapeutic interventions in individuals with chronic PTSD, harnessing a window of ketamine-induced neuroplasticity. While research on ketamine for PTSD is still in its early stages, it brings about the promise of novel and more effective treatments for this disabling condition.

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The emergence of ketamine as a novel treatment for posttraumatic stress disorder

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