Introduction
It is estimated that 1 in every 11 people will be diagnosed with post-traumatic stress disorder (PTSD) in their lifetime [1]. Of people diagnosed with PTSD, about 22.3% fall into the category of having severe symptoms [2]. Current treatment for PTSD includes medications and psychotherapy, “talk therapy” or exposure therapy, but often patients have persisting PTSD symptoms. Fortunately, ketamine has been utilized for disabling cases of PTSD and many patients are finally getting the relief they deserve.
What Exactly Is PTSD?
Post-traumatic stress disorder (PTSD) is a mental health condition that is triggered by either witnessing or experiencing a terrifying event. While some individuals who go through a traumatic event have temporary emotional responses, if the symptoms get worse, present for several months or years, and interfere with daily living, they may be diagnosed with PTSD. Symptoms of PTSD include at least one of the following: unwanted upsetting memories, nightmares, flashbacks, emotional distress after exposure to traumatic reminders and/or physical reactivity after exposure to traumatic reminders.
How PTSD Symptoms Improve With Ketamine
Classic modes of treatment for PTSD include psychotherapy or medications like antidepressants, anxiolytics (medications that reduce anxiety) or antipsychotics. While current forms of treatment often do not provide patients with much relief, repeat IV ketamine treatment has been found to significantly alleviate symptoms of PTSD within hours and results have been seen to last several weeks. Ketamine has been shown to reduce symptoms of:
- Intrusions
- Avoidance
- Negative alterations in cognitions and mood.
- Depression (many patients with PTSD also suffer from major depressive disorder [3])
- Hyperarousal
What’s Going On In the Brain?
Researchers believe that the symptoms experienced by individuals with PTSD are related to a loss of synaptic connectivity [4] and an increased or overactive NMDA receptor. We know that synaptic connectivity is regulated by glutamate, an excitatory neurotransmitter, and that ketamine increases glutamate levels by antagonizing the NMDA receptor. Therefore, it is hypothesized that ketamine uses the NMDA pathway to reverse the effects of stress.
Ketamine & Prevention Against PTSD
Another use of ketamine that has been explored is the use of ketamine as a prophylactic measure to improve a patient’s response to stress. To test this theory, researchers injected a group of rodents with ketamine or saline, then exposed the rats to physical stressors. The researchers then assessed behavioral changes as well as extracellular levels of stress hormones in the rodents. The researchers found that the ketamine injections decreased the effects that the stress had on the rats and reduced the specific neural connections that activate a stress response.
Conclusion
In conclusion, ketamine can be beneficial in reducing symptoms of PTSD in patients who have been refractory to other treatment modalities. Through antagonizing the NMDA receptor, ketamine increases glutamate levels, improving synaptic connectivity and reducing the effects of stress. Ketamine is also being studied in its ability to prevent a stress response if given prophylactically.
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Resources
- What is Posttraumatic Stress Disorder (PTSD)? . American Psychiatric Association. Accessed 2/1/2024
- Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27.
- Repeated Ketamine Infusions Reduce Symptom Severity in Individuals With Chronic Post-Traumatic Stress Disorder. Mount Sinai. Accessed 2/10/2024.
- Liriano, F., Hatten, C., & Schwartz, T. L. (2019). Ketamine as treatment for post-traumatic stress disorder: a review. Drugs in context, 8, 212305. https://doi.org/10.7573/dic.212305
