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Background Over one third of patients with posttraumatic stress disorder (PTSD) do not respond to current interventions. Ketamine presents a potential treatment option; however, its effects are temporary. Administering ketamine alongside psychotherapy is one potential means of prolonging its effects; however, only a few studies have investigated this treatment method to date, and none have tested ketamine with internet-based or electronically delivered cognitive behavioral therapy (e-CBT). Objective This open-label randomized controlled trial aims to assess the efficacy of a combined treatment method of subanesthetic intravenous ketamine and e-CBT for treating patients with PTSD. Methods In total, 20 patients with refractory PTSD recruited from a community clinic will be randomly assigned to either an experimental group (n=10), receiving a combination of ketamine and therapist-administered e-CBT over 14 weeks, or a waitlist control group (n=10), receiving the experimental treatment after 14 weeks. Both groups will be assessed for the symptoms of PTSD and comorbid disorders before treatment, at two midway points, and at the end of the experiment. Results PTSD symptoms of participants in the experimental group are expected to improve significantly more than those of participants in the waitlist control group (P=.05) with a large effect size (η2=0.14). Conclusions This is the first study to assess the relationship between e-CBT and ketamine and their combined ability to treat refractory PTSD. If successful, this study will open web-based, asynchronous therapeutic options for patients with PTSD and will provide new insights into the functional role of glutamate in trauma-related disorders as well as in learning, memory, and fear extinction. Trial Registration ClinicalTrials.gov NCT04771767; https://clinicaltrials.gov/ct2/show/NCT04771767. International Registered Report Identifier (IRRID) PRR1-10.2196/30334

No abstract

BACKGROUND Over a third of patients with Post-Traumatic Stress Disorder (PTSD) do not respond to current interventions. Ketamine is one potential treatment avenue, however its effects are temporary. Administering ketamine alongside psychotherapy is one potential means of prolonging its effects, however, there are few studies investigating this treatment method to date, and none testing ketamine with electronic Cognitive Behavioural Therapy (e-CBT). OBJECTIVE The present study is an open label randomized controlled trial assessing the efficacy of a combined treatment of sub-anesthetic IV ketamine in conjunction with e-CBT to treat patients with PTSD. METHODS Twenty participants with refractory PTSD will be randomly assigned either to an experimental group receiving a combination of ketamine and e-CBT over 14 weeks, or they will be assigned to a waitlist-control group at the end of which they will receive the experimental treatment. Both groups will be assessed for symptoms of PTSD and comorbid disorders before treatment, midway, and at the end of the experiment. RESULTS Symptoms of PTSD for participants in the experimental group are expected to improve significantly more than participants in the waitlist-control group with at least a moderate effect size. CONCLUSIONS This will be the first experiment assessing the relationship between e-CBT and Ketamine and their combined ability to treat refractory PTSD. If successful, this study will open online/asynchronous therapeutic options to patients with PTSD and will provide new insights into the functional role of glutamate in trauma-related disorders as well as in learning, memory, and fear-extinction. CLINICALTRIAL ClinicalTrials.gov database - NCT04771767