Repeated Sub-Anesthetic Ketamine to Enhance Prolonged Exposure Therapy in Post-Traumatic Stress Disorder: A Proof-Of-Concept Study

Shiroma, Paulo; McManus, Eliza S.; Voller, Emily K.; Wels, Joseph; Kaler, Matthew E.; Baltutis, Eric; Thuras, Paul; Erbes, Christopher R.

doi:10.1016/j.biopsych.2020.02.563

Cited by 3 publications

(2 citation statements)

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“…After the exclusion of 2,901 articles based on title or abstract, 23 full-text articles were reviewed and assessed for eligibility. Of these, 13 were further excluded because two were correspondences without chart data ( 38 , 39 ), two were poster abstracts without chart data ( 40 , 41 ), two were NCTs finished without posted results [NCT02398136, NCT02655692], three were abstracts without available full texts ( 42 – 44 ), and four were paired comparisons, which were not considered in this meta-analysis ( Figure 1 ) ( 45 – 48 ). Finally, 10 studies that met (five RCT studies, three case-control studies, and two cohort studies) our predetermined inclusion criteria were included in this study.…”

Section: Resultsmentioning

confidence: 99%

The Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis

Han

Niu

et al. 2022

Front. Psychiatry

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BackgroundPost-traumatic stress disorder (PTSD) is a serious stress-related disorder caused by traumatic experiences. However, identifying a key therapy that can be used for PTSD treatment remains difficult. Ketamine, a well-known dissociative anesthetic, is considered safe to be used in anesthesia, pain management, and antidepressant actions since 1970. At present, it is still controversial whether PTSD can be treated with ketamine. The authors performed a meta-analysis to determine whether the use of perioperative ketamine lowers the incidence of PTSD.MethodsCochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science were searched to examine the use of ketamine for the treatment of PTSD among soldiers with combating experience. Studies were included if they were randomized placebo-controlled, case-control, and cohort studies. The primary outcome was the incidence of PTSD in the later stage of the wounded or burn soldiers. The secondary outcome was the influence of ketamine on PTSD-scale scores for early and chronic PTSD, respectively.ResultsOur search yielded a total of three studies (n = 503 patients) comparing the use of ketamine (n = 349) to control (n = 154). The available evidence showed no significant difference in the incidence of PTSD between combatant soldiers on the battlefield with or without ketamine treatment (risk ratio = 0.81, 95% CI, 0.63–1.04; P = 0.10). In 65 patients from three trials, ketamine was not only ineffective in treating early PTSD but also lead to exacerbation of the disease (risk ratio = 2.45, 95% CI, 1.33–3.58; P < 0.001). However, in 91 patients from the other three trials, ketamine is effective in treating chronic PTSD (risk ratio = −3.66, 95% CI, −7.05 to −0.27; P = 0.03).ConclusionKetamine was not effective on lower the PTSD incidence for soldiers on the battlefield, nor on the PTSD-scale scores in early PTSD patients. However, it may improve the PTSD-scale scores for chronic conditions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255516, PROSPERO, identifier: CRD42021255516.

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Section: Resultsmentioning

confidence: 99%

The Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis

Han

Niu

et al. 2022

Front. Psychiatry

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“…After exclusion by title or abstract of 2901 articles, 23 full text articles were reviewed and assessed for eligibility. Of these, 13 were further excluded because 2 were correspondence without chart data [32,33], 2 were poster abstract without chart data [34,35], 2 were NCT finished without results posted [NCT02398136, NCT02655692], 3 were abstracts unavailable to obtain full texts [36-38] and 4 were paired comparison unconsidered to include in Meta-analysis (Fig.1) [39-42]. Finally, 10 studies that met (5 RCT studies, 3 Case-control studies and 2 Cohort studies) our predetermined inclusion criteria and were incorporated in this study.…”

Section: Resultsmentioning

confidence: 99%

Ketamine for the multivariate effect of PTSD: Systematic review and meta-analysis

Lü

et al. 2021

Preprint

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The aim of this systematic review and meta-analysis was to examine the efficacy, anti-effect of ketamine (intervention) for post-traumatic stress disorder (PTSD) patients during analgesia proceeding and mental illness treatment methods, in comparison with control (midazolam, opioid, saline or placebo). The bibliographic databases Cochrane, Embase, Pubmed and Web of Science were searched from inception to 23 May 2021 for randomized controlled trials, case-control and cohort studies included. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel-Haenszel method. In all, ten trials with 705 patients were included. Confirmed by meta-analysis, ketamine didn't increase the prevalence of PTSD by a risk ratio (95 % CI) of 0.86 (0.61 to 1.20), p = 0.38 in 3 trials with 503 patients. Evidence of a difference was found in the PTSD-scales taken between ketamine and control during short durations (months), with a mean difference (95 % CI) of 2.45 (1.33 to 3.58), p < 0.001 in three trials with 65 patients. Another evidence is shown in chronic PTSD (years), with a mean difference (95 % CI) of -3.66 (-7.05 to -0.27), p = 0.03 in three trials with 91 patients. Sub-group analysis underlined the increased benefit of ketamine administration for those in whom the procedure was more than one week in the chronic PTSD group. The adoption of ketamine for the short duration of PTSD is in avoidance, but for chronic PTSD is recommended and, in the opinion of the authors, should be considered as a new therapy in view of its potential to ameliorate arousal, avoidance and dissociative symptoms, neuroticism after trauma needing more animal research and clinical trials.

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Psychedelics and Evidence-based Psychotherapy

Leone,

McSpadden,

DeMarco

et al. 2024

Psychiatric Clinics of North America

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Repeated Sub-Anesthetic Ketamine to Enhance Prolonged Exposure Therapy in Post-Traumatic Stress Disorder: A Proof-Of-Concept Study

Cited by 3 publications

References 0 publications

The Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis

The Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis

Ketamine for the multivariate effect of PTSD: Systematic review and meta-analysis

Psychedelics and Evidence-based Psychotherapy

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