ketamine for chronic ptsd treatment

By: Jadon Webb, M.D., Ph.D.

Ketamine is one of the most effective treatments we have for treating severe and treatment-resistant depression. We also know it is unusually good at treating feelings of hopelessness and suicidal thoughts. 

Given how remarkably effective ketamine has been at treating depression, there has been intense interest in the clinical and research community around what other kinds of mental health problems ketamine might treat. For years, clinicians incidentally noticed that it seemed to help clients who had experienced trauma, and were suffering from  post-traumatic stress disorder (PTSD). Ketamine was increasingly being given for PTSD, with reports of it being highly effective, but no rigorous study had yet been done on whether it truly was effective, especially for chronic, long term PTSD.

This year (2021), a well-designed, randomized clinical study was published in the American Journal of Psychiatry confirming that ketamine does seem to be very effective at treating chronic PTSD.  This is extremely good news for anyone suffering from PTSD. 

This study treated 30 patients with chronic PTSD, and gave them six IV ketamine infusions over 2 weeks (a typical treatment protocol). It is worth noting a particularly impressive part of this study: their control group was not the usual inactive placebo as is done in most of these types of studies (such as giving a saline injection). Instead, the placebo arm of the study was the benzodiazepine midazolam, which produces clear psychiatric effects when given intravenously.  

Using midazolam for the control group was an elegant way to separate out the placebo effect, and see if the ketamine was producing real results in treating the PTSD. If study participants could feel psychoactive effects of receiving an IV infusion, there would be a strong chance they could experience a strong placebo effect, compared to if they had received something inactive like saline. By having both the active and placebos produce psychiatric effects, this problem is reduced, and it makes the results of this study much stronger and believable.

 The results of the study are quite impressive. Two-thirds of study participants  responded to ketamine, while only 20% seemed to benefit from the midazolam control group. This is a very large effect for these types of clinical studies, much larger than is typically seen with oral medications. In plain language, it indicates that ketamine was extremely effective for treating these patients suffering from chronic PTSD.

Bottom Line: If you or someone you are caring for is suffering from severe PTSD, or chronic PTSD that is not responding to conventional medications,  it may be worth considering ketamine as a next step. There is great hope for this sometimes difficult to treat disorder!

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