There is conflicting evidence for the use of Ketamine treatment for PTSD

Ketamine is not FDA Approved for the treatment of PTSD

24. Pediatrics. 2015 Sep;136(3):e694-6. doi: 10.1542/peds.2014-4152. Epub 2015 Aug
10.

Remission From Behavioral Dysregulation in a Child With PTSD After Receiving
Procedural Ketamine.

Donoghue AC(1), Roback MG(2), Cullen KR(3).

Author information:
(1)Department of Psychiatry, linds368@umn.edu. (2)Department of Pediatrics, and
Department of Emergency Medicine University of Minnesota, Minneapolis, Minnesota.
(3)Department of Psychiatry.

Ketamine, an N-methyl-D-aspartate-type glutamate receptor antagonist, has long
been used for anesthesia and has recently been investigated for its rapid
antidepressant effects in adults with treatment-resistant depression and
posttraumatic stress disorder (PTSD). We report a case of a child with PTSD and
episodes of severe aggression and emotional dysregulation that were refractory to
multiple medical and behavioral interventions. This child demonstrated sustained
(8-13 days) remission from these symptoms when exposed to ketamine in the context
of 2 procedures. We review the sparse literature on the uses of ketamine for
behavioral purposes in children. This case suggests that ketamine should be
further explored as a potential treatment option for children with severe
refractory behavioral aggression.

PMID: 26260717 [PubMed - in process]

179. JAMA Psychiatry. 2014 Jun;71(6):681-8. doi: 10.1001/jamapsychiatry.2014.62.

Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress
disorder: a randomized clinical trial.

Feder A(1), Parides MK(2), Murrough JW(3), Perez AM(4), Morgan JE(1), Saxena
S(5), Kirkwood K(2), Aan Het Rot M(6), Lapidus KA(3), Wan LB(1), Iosifescu D(3),
Charney DS(7).

Author information:
(1)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York,
New York. (2)Department of Health Evidence and Policy, Icahn School of Medicine
at Mount Sinai, New York, New York. (3)Department of Psychiatry, Icahn School of
Medicine at Mount Sinai, New York, New York3Department of Neuroscience, Icahn
School of Medicine at Mount Sinai, New York, New York. (4)Department of
Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York.
(5)School of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
(6)Department of Psychology, University of Groningen, Groningen, the Netherlands.
(7)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York,
New York3Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New
York, New York7Department of Pharmacology and Systems Therapeutics, Icahn School
of Medicine at.

Comment in
JAMA Psychiatry. 2015 Jan;72(1):95-6.
JAMA Psychiatry. 2015 Jan;72(1):94-5.

IMPORTANCE: Few pharmacotherapies have demonstrated sufficient efficacy in the
treatment of posttraumatic stress disorder (PTSD), a chronic and disabling
condition.
OBJECTIVE: To test the efficacy and safety of a single intravenous subanesthetic
dose of ketamine for the treatment of PTSD and associated depressive symptoms in
patients with chronic PTSD.
DESIGN, SETTING, AND PARTICIPANTS: Proof-of-concept, randomized, double-blind,
crossover trial comparing ketamine with an active placebo control, midazolam,
conducted at a single site (Icahn School of Medicine at Mount Sinai, New York,
New York). Forty-one patients with chronic PTSD related to a range of trauma
exposures were recruited via advertisements.
INTERVENTIONS: Intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and
midazolam (0.045 mg/kg).
MAIN OUTCOMES AND MEASURES: The primary outcome measure was change in PTSD
symptom severity, measured using the Impact of Event Scale-Revised. Secondary
outcome measures included the Montgomery-Asberg Depression Rating Scale, the
Clinical Global Impression-Severity and -Improvement scales, and adverse effect
measures, including the Clinician-Administered Dissociative States Scale, the
Brief Psychiatric Rating Scale, and the Young Mania Rating Scale.
RESULTS: Ketamine infusion was associated with significant and rapid reduction in
PTSD symptom severity, compared with midazolam, when assessed 24 hours after
infusion (mean difference in Impact of Event Scale-Revised score, 12.7 [95% CI,
2.5-22.8]; P = .02). 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. Ketamine was generally well
tolerated without clinically significant persistent dissociative symptoms.
CONCLUSIONS AND RELEVANCE: This study provides the first evidence for rapid
reduction in symptom severity following ketamine infusion in patients with
chronic PTSD. If replicated, these findings may lead to novel approaches to the
pharmacologic treatment of patients with this disabling condition.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00749203.

PMID: 24740528 [PubMed - indexed for MEDLINE]

180. Ann Clin Psychiatry. 2014 May;26(2):145.

Treatment-refractory depression: a case of successful treatment with intranasal
ketamine 10%.

Clark P(1).

Author information:
(1)Private Practice, Chapel Hill, NC, USA. E-mail: Trisheclark@aol.com.

PMID: 24501735 [PubMed - indexed for MEDLINE]

281. AANA J. 2013 Apr;81(2):118-9.

Effects of ketamine on major depressive disorder in a patient with posttraumatic
stress disorder.

Womble AL(1).

Author information:
(1)Southeastern Pain Management, Gadsden, Alabama, USA. Arthur.Womble@us.army.mil

Ketamine has been used in anesthesia for many years and in various environments
with an acceptable safety margin. The side effects of hallucinations and paranoid
thoughts need to be overcome for acceptance of ketamine infusion in mainstream
psychiatry. In this case report, the anesthesia department was consulted because
of familiarity with the medication and the ability to modulate unacceptable side
effects with its use as is done in monitored anesthesia care. It is proposed that
ketamine has potential for treatment of major depression associated with
posttraumatic stress disorder (PTSD) in combat veterans. This patient, who had
debilitating and treatment-resistant major depression and PTSD, was treated by
intravenous infusion of ketamine and experienced substantial short-term
resolution of symptoms.

PMID: 23971230 [PubMed - indexed for MEDLINE]

Against:

198. Eur Neuropsychopharmacol. 2014 Mar;24(3):469-79. doi:
10.1016/j.euroneuro.2013.08.007. Epub 2013 Sep 12.

Immediate ketamine treatment does not prevent posttraumatic stress responses in
an animal model for PTSD.

Juven-Wetzler A(1), Cohen H(2), Kaplan Z(2), Kohen A(1), Porat O(1), Zohar J(3).

Author information:
(1)The Chaim Sheba Medical Center, Division of Psychiatry, Sackler Medical
School, Tel Aviv University, Tel Hashomer, Israel. (2)Ministry of Health, Anxiety
and Stress Research Unit, Ben-Gurion University of the Negev Faculty of Health
Sciences, Beer Sheva, Israel. (3)The Chaim Sheba Medical Center, Division of
Psychiatry, Sackler Medical School, Tel Aviv University, Tel Hashomer, Israel;
Sackler Medical School, Tel Aviv University, Israel. Electronic address:
joseph.zohar@sheba.health.gov.il.

Clinical studies suggest that administration of ketamine hydrochloride-an
antagonist at the N-methyl-d-aspartate ionophore-provides short-term amelioration
for depressive symptoms. The effects of a brief course of ketamine given
immediately following exposure to psychogenic stress on the behavioral stress
responses were assessed in an animal model of posttraumatic stress disorder.
Animals exposed to stress were treated 1h later with ketamine (0.5, 5, and 15
mg/kg) or vehicle for three days (N = 107). Outcome measures included behavior in
the elevated plus maze (EPM) and acoustic startle response (ASR) tests 30 days
after initial exposure and freezing behavior upon exposure to a trauma-cue on day
31. Pre-set cut-off behavioral criteria classified exposed animals according to
their EPM and ASR response-patterns into "extreme," "minimal," or "partial"
behavioral response for analysis of prevalence rates of "PTSD-like behavior."
Circulating corticosterone levels were assessed 20 min after injection of
ketamine in exposed and unexposed animals (N = 62). The dexamethasone suppression
test was used to assess negative feedback inhibition of the HPA axis. Prevalence
rates of extremely-, partially-, or minimally-disrupted behavior demonstrated
that ketamine administered immediately following stress exposure was ineffective
in alleviating "PTSD-like behavior" at day 30 after exposure. Administration of
ketamine was associated with increase in freezing behavior after exposure to a
trauma-cue on day 31. Corticosterone levels were significantly suppressed by
ketamine only in the exposed animals. Administration of ketamine immediately
following trauma-exposure may not only be ineffective but actually detrimental in
the long term. A disruption of the post-stress HPA-response has been raised as a
contributing factor.

PMID: 24239430 [PubMed - indexed for MEDLINE]