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

Abstract

Abstract Post-traumatic stress disorder (PTSD) affects ~ 6% of adolescents and adults in the US. Increased N-methyl-D-aspartate (NMDA) receptor activation leads to heightened intrusive memories and is associated with an increased risk of developing PTSD. Ketamine is an NMDA antagonist with ultra-rapid therapeutic action for treatment-resistant depression and suicide. In this meta-analysis, we assessed the effect of subanesthetic ketamine infusion on PTSD severity. Six databases were investigated according to PRISMA guidelines with quality assessments according to the NIH Quality Assessment tool. Eligible criteria included: 1) Randomized Control Trial (RCT) or cohort study 2) Used a single or multiple ketamine infusion(s) 3) Studies using another treatment for PTSD to which (2) is added 4) PTSD symptoms are measured at pre-infusion baseline and up to at least 40 minutes after infusion using a valid PTSD symptom measurement scale 5) Study included ≥ 5 patients. The primary outcome was the first measured value of PTSD symptoms after treatment completion. Meta-analysis using a random effects model was performed on pre-to-post changes in PTSD severity within ketamine treated patients and to compare ketamine to control outcomes. The search retrieved 526 articles. Nine articles met inclusion criteria: 5 RCTs and 4 cohort studies. Meta-analysis revealed that ketamine infusion reduced PTSD symptom severity (pre-post ketamine: standardized mean difference pre-to-post: 3.07, 95% confidence interval 1.54–4.60, P < 0.01). These results support ketamine infusions as an effective treatment modality for PTSD symptoms. Ketamine-assisted psychotherapy is shown to enhance ketamine effect and aid in prolonging remission. Further research is needed to provide effective and long-lasting PTSD treatment.