Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder
Adriana Feder, Michael K. Parides, James W. Murrough, Andrew M. Perez, Julia E. Morgan, Shireen Saxena, Katherine Kirkwood, Marije Aan Het Rot, Kyle Lapidus, Le-Ben Wan, Dan V. Iosifescu, Dennis S. Charney
JAMA Psychiatry April 16, 2014 DOI: 10.1001/jamapsychiatry.2014.62 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 41 |
| Population | Patients with chronic PTSD related to a range of trauma exposures |
| Interventions | Ketamine hydrochloride Midazolam |
| Dose | 0.5 mg/kg ketamine; 0.045 mg/kg midazolam |
| Duration | 24-hour assessment after single infusion |
| Topics | Depression Ketamine Esketamine PTSD |
| Keywords | Placebo Clinical global impression Rating scale Anesthesia Crossover study Dissociative Midazolam Randomized controlled trial Adverse effect Mania Bipolar disorder Sedation Mood |
| Citations | 618 |
| Registration | NCT00749203 |
| Key findings | Ketamine infusion produced a significantly greater reduction in PTSD symptom severity at 24 hours compared to midazolam. |
Abstract
Importance: Few pharmacotherapies have demonstrated sufficient efficacy in the treatment of posttraumatic stress disorder (PTSD), a chronic and disabling condition.
Objective: To test the efficacy and safety of a single intravenous subanesthetic dose of ketamine for the treatment of PTSD and associated depressive symptoms in patients with chronic PTSD. DESIGN, SETTING, AND
Participants: Proof-of-concept, randomized, double-blind, crossover trial comparing ketamine with an active placebo control, midazolam, conducted at a single site (Icahn School of Medicine at Mount Sinai, New York, New York). Forty-one patients with chronic PTSD related to a range of trauma exposures were recruited via advertisements.
Interventions: Intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and midazolam (0.045 mg/kg).
Main Outcomes and Measures: The primary outcome measure was change in PTSD symptom severity, measured using the Impact of Event Scale-Revised. Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression-Severity and -Improvement scales, and adverse effect measures, including the Clinician-Administered Dissociative States Scale, the Brief Psychiatric Rating Scale, and the Young Mania Rating Scale.
Results: Ketamine infusion was associated with significant and rapid reduction in PTSD symptom severity, compared with midazolam, when assessed 24 hours after infusion (mean difference in Impact of Event Scale-Revised score, 12.7 [95% CI, 2.5-22.8]; P = .02). Greater reduction of PTSD symptoms following treatment with ketamine was evident in both crossover and first-period analyses, and remained significant after adjusting for baseline and 24-hour depressive symptom severity. Ketamine was also associated with reduction in comorbid depressive symptoms and with improvement in overall clinical presentation. Ketamine was generally well tolerated without clinically significant persistent dissociative symptoms.
Conclusions: AND RELEVANCE: This study provides the first evidence for rapid reduction in symptom severity following ketamine infusion in patients with chronic PTSD. If replicated, these findings may lead to novel approaches to the pharmacologic treatment of patients with this disabling condition.
Trial Registration: clinicaltrials.gov Identifier: NCT00749203.
In the evidence
This study is part of the evidence base for 3 syntheses in the library. Here is how each one recorded it.
-
A single intravenous ketamine infusion produced a significantly greater reduction in PTSD symptom severity at 24 hours than midazolam.
Synthesized
-
A single ketamine infusion produced a significantly greater reduction in PTSD symptom severity at 24 hours than midazolam.
Synthesized
-
State of the evidence: PTSD Supports
A single ketamine infusion produced a significantly greater reduction in PTSD symptom severity at 24 hours compared to midazolam.
Synthesized
Comparable studies
Other randomized controlled trials on ketamine for PTSD, most cited first.