Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review.
Lisa Burback, Suzette Brémault-phillips, Mirjam J Nijdam, Alexander C. Mcfarlane, Eric Vermetten
Current Neuropharmacology 2024 DOI: 10.2174/1570159X21666230428091433 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative state-of-the-art review Peer reviewed |
|---|---|
| Topics | Ketamine PTSD |
| Keywords | Posttraumatic stress disorder Intervention Moral injury Neuromodulation. Psychedelic Psychotherapy Psychotropic drugs |
| Citations | 187 |
| Key findings | Chronic PTSD is a systemic disorder with high allostatic load, and current evidence-based treatments often yield suboptimal outcomes, driving development of novel interventions including early interventions, medication augmentation, psychedelics, and neuromodulation. |
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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Argues that current evidence-based PTSD treatments often yield suboptimal outcomes, driving development of novel interventions including psychedelics.
Synthesized
Comparable studies
Other narrative reviews on ketamine for PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Glutamate and post-traumatic stress disorder: toward a psychobiology of dissociation. | 1999 | Review | |
| The Psychedelic Future of Post-Traumatic Stress Disorder Treatment | 2024 | Comprehensive review | |
| Diverse therapeutic developments for post-traumatic stress disorder (PTSD) indicate common mechanisms of memory modulation. | 2022 | Review | |
| The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. | 2023 | Review | |
| Therapeutic potential of ketamine for alcohol use disorder. | 2021 | Review |