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Combined Effects of Nasal Ketamine and Trauma-Focused Psychotherapy in Treatment-Resistant Post-Traumatic Stress Disorder: A Pilot Case Series.

Judith Rohde, Elena Hickmann, Marco Buchmann, Golo Kronenberg, Stefan Vetter, Erich Seifritz, Birgit Kleim, Sebastian Olbrich

Behavioral sciences (Basel, Switzerland) August 16, 2024 DOI: 10.3390/bs14080717 (opens in new tab)

Study at a glance

AI-extracted from the abstract
Characteristics Pilot case series Randomized Case report Peer reviewed
Sample size 3
Population Individuals with chronic, treatment-resistant PTSD
Interventions Ketamine Trauma-focused psychotherapy
Dose 0.5 mg/kg
Duration 8-week intervention
Topics Ketamine PTSD Esketamine
Keywords Ketamine assisted Trauma focused PTSD-Treatment Ketamine-therapy Trauma-focused-psychotherapy Mental-health-innovation Clinical-research
Citations 7
Key findings Combining nasally administered ketamine with trauma-focused psychotherapy produced clinically relevant reductions in PTSD and depressive symptoms in three patients with chronic, treatment-resistant PTSD.

Abstract

This pilot case series investigated the feasibility and efficacy of an eight-week therapy program, combining nasally administered ketamine (0.5 mg/kg) with trauma-focused psychotherapy, for individuals with chronic, treatment-resistant post-traumatic stress disorder (PTSD). Three patients with chronic, treatment-resistant PTSD underwent the eight-week therapy program. Clinical assessments included the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Hamilton Depression Rating Scale (HAMD) at baseline, post-assessment, and follow-up assessment, along with additional measures assessing other relevant symptoms and side effects. The results demonstrated clinically relevant reductions in PTSD symptoms, indicated by a change in the CAPS-5 score at post-assessment (M = -18.00; SE = 6.48) and follow-up assessment (M = -25.33, SE = 5.58). Additionally, depressive symptoms showed notable improvement, with changes in HAMD scores at post-assessment (M = -8.33, SE = 3.07) and follow-up assessment (M = -9.00, SE = 3.77). Positive effects were also observed in anxiety reduction, decreased dissociations, and improvements in emotion regulation and disturbances of self-organization. Despite potential variations in clinical profiles among the patients, the therapy program demonstrated positive outcomes for all participants. Nasally administered ketamine was well tolerated and resulted in immediate symptom reduction in tension, anxiety, and common PTSD symptoms. However, to validate these findings and compare treatment efficacy, future randomized controlled trials are warranted, especially in comparison with trauma-focused therapy alone.

Comparable studies

Other case reports and case series on ketamine for PTSD, most cited first.

Study Year Design Participants
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder Patients with treatment-resistant depression and comorbid PTSD 2023 Case series n = 5
The Effect of Ketamine-Assisted Group Therapy on Treatment-Resistant Mental Health Conditions in Firefighters: A Prospective Observational Case Series. Firefighters with mental health diagnoses 2025 Observational case series
Dramatic and persistent relief from chronic suicidality, emotional disturbances, and trauma symptomatology with oral ketamine and memantine in refractory depression with complex PTSD A 27-year-old woman with chronic recurrent depressive disorder and complex... 2024 Case report n = 1
Case Report: Successful management of psychogenic non-epileptic seizures with intranasal esketamine. Patient with treatment-resistant depression and psychogenic non-epileptic seizures 2025 Case report n = 1

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