The impact of ketamine on posttraumatic stress disorder (PTSD) symptomatology in trauma-exposed populations: a narrative review.
Minaal Ahmed Malik, Michele Halasa, Jack Chia, Venera Derguti, Holly Hathway, Fahad Hussain, Abdel Saad
Journal of trauma and injury June 1, 2026 DOI: 10.20408/jti.2025.0086 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Randomized Peer reviewed |
|---|---|
| Population | Trauma-exposed populations |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg |
| Topics | Ketamine Esketamine PTSD |
| Keywords | Critical care Neurobiology Post-traumatic stress disorders |
| Key findings | Ketamine's effect on PTSD depends on dose and timing: a single 0.5 mg/kg infusion may reduce symptoms within 24 hours, but acute trauma use may worsen dissociation and stress responses. |
Abstract
Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is widely used in trauma and emergency medicine for its rapid analgesic and sedative properties. While its efficacy in acute pain management is well established, concerns persist regarding its long-term psychological effects, particularly its potential role in the development of posttraumatic stress disorder (PTSD). Some studies indicate that ketamine may provide rapid symptom relief in PTSD, whereas others raise concerns about its contribution to dissociative states and maladaptive memory consolidation. This narrative review examines existing literature on ketamine's influence on PTSD symptomatology in trauma-exposed populations. A comprehensive assessment of randomized controlled trials and observational studies was undertaken to explore ketamine's effects on dissociation, memory processing, and long-term psychiatric outcomes. Relevant studies were identified from major medical databases, and findings were synthesized to present an integrated overview of ketamine's psychological impact in trauma care settings. Clinical trials suggest that a single intravenous infusion of ketamine (0.5 mg/kg) may significantly reduce PTSD symptoms within 24 hours compared to midazolam, with improvements in overall clinical presentation and no lasting dissociative effects. Conversely, some observational studies have linked ketamine use in acute trauma care to heightened dissociation, hyperarousal, and stress symptoms during early follow-up. Research on burn patients receiving intraoperative ketamine suggests a possible reduction in PTSD incidence, although a later study reported no significant difference compared with non-ketamine controls. The relationship between ketamine and PTSD is complex, with effects appearing to depend on dose and timing of administration. While perioperative ketamine may confer protective benefits against long-term psychiatric sequelae, immediate post-trauma administration may worsen dissociative symptoms and acute stress responses. Further well-controlled clinical trials are needed to refine dosing protocols and identify patient-specific risk factors, including preexisting psychiatric conditions, to better guide its use.
Comparable studies
Other narrative reviews on ketamine for PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. | 2024 | Narrative state-of-the-art review | |
| 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 |
Citations in the library
Cites 8
- Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) CNS Neuroscience & Therapeutics April 10, 2013
- Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder JAMA Psychiatry April 16, 2014
- Brain Changes Associated With Long-Term Ketamine Abuse, A Systematic Review Frontiers in Neuroanatomy March 18, 2022
- The dissociative and analgesic properties of ketamine are independent Anesthesiology September 4, 2020
- Molecular signatures of astrocytes and microglia maladaptive responses to acute stress are rescued by a single administration of ketamine in a rodent model of PTSD. Translational Psychiatry May 25, 2024
and 3 more in the library