Unmasking the psychiatric impact of ketamine in burn patients: Elevated risk of depression and acute stress reactions
Davon Lee, Elizabeth Beyene, Da’Jhai Monroe, Elijah McMillan, Sierra Lyles, Marqus Creavalle, Biniam Zelelew, Syed Fahad Gillani, Mekdem Bisrat, Samrawit Zinabu, Miriam Michael
Journal of Surgery and Medicine June 11, 2026 DOI: 10.28982/josam.8322 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective cohort study Peer reviewed |
|---|---|
| Sample size | 7,036 |
| Population | Patients aged 12 to 90 years with burn injuries involving at least 10% total body surface area, identified in the TriNetX global health research network |
| Intervention | Ketamine |
| Duration | Exposure assessed within one month of injury; outcomes evaluated over one year |
| Topics | Depression Esketamine Ketamine |
| Key findings | Ketamine exposure within one month of major burn injury was associated with higher one-year risks of depression (4.9% vs. 3.8%) and acute stress reaction (2.0% vs. 0.8%), but not PTSD (0.6% vs. 0.6%). The authors conclude these findings support routine psychological screening and follow-up when ketamine is used for burn-related analgesia and sedation. |
Abstract
Background/Aim: Ketamine is frequently administered for analgesia and sedation during burn dressing changes, but its potential psychological impact remains a concern. This study assessed whether ketamine exposure during early burn care is associated with subsequent depression, acute stress reaction (ASR), or post-traumatic stress disorder (PTSD) in patients with major burns.
Methods: A retrospective cohort study was conducted using the TriNetX global health research network. Patients aged 12 to 90 years with burn injuries involving ≥10% total body surface area were included. Two cohorts were defined according to ketamine exposure within one month of injury. Propensity score matching (1:1) was performed for age, sex, and race, yielding 3,518 patients per group. Outcomes were evaluated over one year using diagnostic codes for depression, ASR, and PTSD. Analyses included risk estimates, odds ratios, Kaplan-Meier methods, and hazard ratios.
Results: Ketamine exposure was associated with a higher risk of depression (4.9% vs. 3.8%; odds ratio 1.30; hazard ratio 1.24; P = 0.012) and ASR (2.0% vs. 0.8%; odds ratio 2.56; hazard ratio 2.41; P < 0.001). PTSD incidence was similar between cohorts (0.6% vs. 0.6%; odds ratio 1.03; hazard ratio 0.99; P = 0.952).
Conclusion: In patients with major burns, ketamine exposure during early care was associated with increased risks of depression and ASR, but not PTSD. These findings support routine psychological screening and follow-up when ketamine is used for burn-related analgesia and sedation.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |