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

Abstract

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.

Is Ketamine Infusion an Effective Treatment for Post-Traumatic Stress Disorder? A Meta-Analysis

“…Our study supports Du et al's results [33] and builds on the importance of including psychotherapy with pharmacological treatment for PTSD. Psychotherapy is a rst-line treatment for PTSD, though its effects are short-lived.…”

“…A paired-samples t test showed a signi cant decrease (p = 0.003) in PCL-5 scores (pre-treatment mean 55. 33, SD = 11.52 to post-treatment mean 27.11, SD = 12.36) 95% CI (13.11, 43.33), Cohen's d = 1.44.…”

“…Interestingly, it was shown that ketamine was not only ineffective in treating early PTSD but also led to exacerbation of the PTSD [33]. However, in their longitudinal study analysis, ketamine was shown to be effective in treating chronic PTSD [33]. It is possible that there is an inadequate consolidation of traumatic memories in acute PTSD whereby ketamine cannot induce its modulatory effects on early stress induced neurons.…”

Ренесанс Психоделічної Терапії Та Її Значення Для України

“…Далі з'явилися дані про ефективність кетамінової терапії при тривожних розладах [156], обсесивно-компульсивному розладі [6,99], ПТСР [40], розладах харчової поведінки, залежностях від вживання психоактивних речовин [99] та хронічних больових синдромах [15].…”

A single dose of ketamine enhances early life stress-induced aggression with no effect on fear memory, anxiety-like behavior, or depression-like behavior in mice.

“…Ketamine also has a moderate effect treating agitation and aggression associated with PTSD (Liriano et al, 2019; Tran & Mierzwinski-Urban, 2019). However, conflicting reports have shown that ketamine is not effective in ameliorating PTSD-like symptoms in soldiers on the battlefield and, in some cases, can even exacerbate them (Du et al, 2022; McGhee et al, 2014; Mion et al, 2017; Schönenberg et al, 2008).…”