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Ketamine for PTSD

Studies whose primary subject is both Ketamine and PTSD, with an evidence synthesis read across the most-cited and most recent of them.

State of the evidence

Synthesized

Synthesized from 25 studies in the library · AI-generated, grounded in the abstracts below

Found by searching the library for Ketamine, racemic ketamine, arketamine, R-ketamine, PTSD, post-traumatic stress disorder, then ranked by relevance.

The research suggests ketamine can produce rapid, substantial reductions in PTSD symptoms, with randomized trials showing significantly greater improvement than an active placebo (midazolam) at 24 hours and after repeated infusions, and large observational cohorts reporting clinically meaningful benefit. Effects appear strongest in treatment-resistant or more severely symptomatic patients, and combining ketamine with psychotherapy is a common approach. However, most randomized evidence comes from small samples, several reviews rate the overall quality of evidence as low to very low, and durability beyond a few weeks is not well established.

Evidence by study

Direction is which way each study's own result points, not our rating of the study.

What the directions mean
Supports:
the study found the intervention worked, or its hypothesis held.
Opposes:
it found the opposite, no benefit or a harm.
No effect:
no significant difference either way.
Mixed:
effects in both directions within the same study.
Unclear:
the abstract does not report a direction.
Study Design Sample size Direction Finding
Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder 2014 RCT 41 Supports A single intravenous ketamine infusion produced a significantly greater reduction in PTSD symptom severity at 24 hours than midazolam.
A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder. 2021 RCT 30 Supports Six ketamine infusions over two weeks produced significantly greater improvement in PTSD and depression scores than midazolam, with a large effect size and a 67% responder rate.
Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. 2024 narrative review Unclear Argues that current evidence-based PTSD treatments often yield suboptimal outcomes, driving development of novel interventions including psychedelics.
Glutamate and post-traumatic stress disorder: toward a psychobiology of dissociation. 1999 review Unclear Argues that stress-induced glutamate release and NMDA antagonist effects may contribute to dissociative symptoms in PTSD, and that drugs reducing glutamate release warrant exploration in traumatized individuals.
The Psychedelic Future of Post-Traumatic Stress Disorder Treatment 2024 comprehensive review Supports Reports that initial clinical trials demonstrate potential value of psychedelic-assisted therapy, including ketamine, for PTSD, while standard-of-care therapies leave many patients symptomatic.
d-Serine is a potential biomarker for clinical response in treatment of post-traumatic stress disorder using (R,S)-ketamine infusion and TIMBER psychotherapy: A pilot study. 2018 pilot study Unclear Suggests d-serine may serve as a biomarker for clinical response in PTSD patients treated with ketamine infusion and TIMBER psychotherapy.
Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. 2018 retrospective review 37 Supports Oral ketamine was associated with a 70% reduction in inpatient hospital days and a 65% reduction in psychiatric admissions, with no serious adverse events or tolerance.
Diverse therapeutic developments for post-traumatic stress disorder (PTSD) indicate common mechanisms of memory modulation. 2022 review Supports Argues that early evidence supports beneficial effects of psychedelics including ketamine for PTSD, but that large-scale clinical trials are needed before clinical use.
Efficacy of Psychoactive Drugs for the Treatment of Posttraumatic Stress Disorder: A Systematic Review of MDMA, Ketamine, LSD and Psilocybin 2020 systematic review 9 Mixed Rated evidence for ketamine as a stand-alone treatment for comorbid PTSD and depression as very low, and ketamine plus psychotherapy as low, while MDMA plus psychotherapy was rated moderate.
The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. 2023 review Supports Synthesizes clinical evidence across case reports, chart reviews, open-label studies, and randomized trials and reports encouraging signals of therapeutic safety, efficacy, and durability, despite high clinical heterogeneity.
Therapeutic potential of ketamine for alcohol use disorder. 2021 review Unclear Argues that ketamine's effects in depression and stress disorders such as PTSD suggest a potential role for treating alcohol use disorder.
A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers With PTSD and Depression 2022 quality improvement evaluation with mixed methods 94 Supports A ketamine-assisted psychotherapy program delivered in a community-of-practice group model led to clinically significant improvements in depression, PTSD, generalized anxiety, and work/life functionality.
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series 2022 retrospective case series 35 Supports Repeated intranasal (S)-ketamine was associated with improvements in both depression and PTSD symptoms, with PTSD effects appearing temporally and individually distinct from depression effects.
Ketamine ameliorates post-traumatic social avoidance by erasing the traumatic memory encoded in VTA-innervated BLA engram cells. 2024 experimental animal study Supports A single subanesthetic dose of ketamine given within the re-exposure time window reduced social avoidance in mice by decreasing activity and quantity of reactivated basolateral amygdala engram cells.
Ketamine as a therapeutic agent in major depressive disorder and posttraumatic stress disorder: Potential medicinal and deleterious effects. 2023 review Unclear Reviews ketamine's mechanisms, clinical trial results, and side effects as a potential therapeutic for major depressive disorder and PTSD.
Blood biomarker changes in response to low-dose oral ketamine treatment in adults with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) 2026 observational cohort 35 Supports Low-dose oral ketamine was associated with improvements in depression, anxiety, stress, social functioning, suicidal ideation, and well-being in both groups, with no detectable difference in biological response between groups.
Psychedelic Therapies in the Management of Post-Traumatic Stress Disorder 2026 review Supports Reports that ketamine offers rapid symptom alleviation, notably beneficial for treatment-resistant cases with high risk of self-harm and suicide, while MDMA-assisted therapy showed high efficacy.
Ketamine effects on EEG and their links to therapy differ across treatment-resistant major depression, post-traumatic stress disorder, and obsessive-compulsive disorder 2026 experimental within-subjects placebo-controlled 42 Mixed Ketamine's EEG effects and their correlation with symptom improvement differed by band, electrode, and diagnosis, with treatment-resistant PTSD showing dose-dependent alpha changes and treatment-resistant MDD showing none.
Ketamine-assisted psychotherapy for posttraumatic stress disorder: a systematic review and individual participant data meta-analysis of predictors of treatment effects. 2026 systematic review and individual participant data meta-analysis 533 Supports Higher baseline PTSD severity was the most robust predictor of symptom reduction after combined ketamine and psychotherapy, with more sessions and shorter treatment duration also associated with greater improvement.
Effect of esketamine-assisted regional block on post-traumatic stress disorder after radical lung cancer surgery: A retrospective clinical study 2026 retrospective observational cohort 218 Supports Esketamine-assisted regional block was associated with lower postoperative PTSD prevalence at three months (19.6% vs 37.7%) and lower 24-hour cortisol and IL-6 levels.
At-Home Telehealth-Supported Subcutaneous Ketamine Therapy in Adults With Moderate to Severe Depression, Anxiety, or PTSD: A Real-World Observational Study of Safety, Feasibility, and Clinical Outcomes in a Large, Heterogeneous Cohort in the United States. 2026 retrospective observational study 3870 Supports At-home subcutaneous ketamine was associated with large, clinically meaningful reductions in depression, anxiety, and PTSD symptoms with low adverse events.
Acute pretrauma ethanol exacerbates PTSD-like phenotype in rats and is reversed by early intranasal ketamine 2026 experimental animal study Supports Pre-trauma ethanol exposure increased PTSD-like phenotype prevalence and hippocampal dendritic retraction, while early post-trauma intranasal ketamine reduced these effects.
The impact of ketamine on posttraumatic stress disorder (PTSD) symptomatology in trauma-exposed populations: a narrative review. 2026 narrative review Mixed Reports that a single 0.5 mg/kg infusion may reduce PTSD symptoms within 24 hours, but that ketamine use in acute trauma care has been linked to heightened dissociation, hyperarousal, and stress symptoms.
Clinical Outcomes of Ketamine Therapy for Depression, Anxiety, and PTSD in Post-TBI Patients 2026 retrospective chart review 35 Supports Ketamine treatment was associated with large effect sizes (32.7% to 65.6% symptom reduction) and 72% response and 45% remission rates, with parenteral routes outperforming oral.
Longitudinal Assessment of Ketamine-Assisted Community of Practice Therapy: A Retrospective 5-Year Study on Depression, Anxiety and PTSD 2026 retrospective cohort analysis 305 Supports Depression, anxiety, and PTSD symptoms significantly improved after a 12-week ketamine-assisted therapy program (p<0.001, d>0.8), with higher baseline severity predicting greater improvement.

Points of agreement

  • Randomized trials with an active placebo (midazolam) show ketamine produces significantly greater and rapid PTSD symptom reduction.
  • Multiple observational cohorts and chart reviews report clinically meaningful improvements in PTSD symptoms with ketamine, including in treatment-resistant and comorbid populations.
  • Higher baseline PTSD symptom severity is repeatedly associated with greater improvement.
  • Combining ketamine with psychotherapy is a common and reportedly promising approach.
  • Ketamine is generally described as having a favorable or mild adverse-event profile in these studies.

Conflicts

  • A systematic review rates the evidence for ketamine in PTSD as very low to low, contrasting with the more encouraging conclusions of narrative reviews and observational studies.
  • One narrative review notes that ketamine in acute trauma care has been linked to heightened dissociation and stress symptoms, while clinical trials report no lasting dissociative effects.
  • Evidence quality ratings differ markedly across reviews, from 'encouraging signals' to 'very low' certainty.

Gaps

  • Durability of benefit beyond a few weeks is not well established.
  • Most randomized evidence comes from very small samples (30-41 participants).
  • Blinding is difficult with psychoactive ketamine and an active placebo, and several included studies were unblinded or of poor quality.
  • Optimal dose, route (IV, IM, intranasal, oral, subcutaneous), and number of sessions are not established.
  • Long-term safety and risk of dissociation or maladaptive memory consolidation in acute trauma settings remain unclear.
  • Predictors of response beyond baseline severity are not well characterized.
Browse these studies in the library

Common questions

What does the research agree on about ketamine for PTSD?
  • Randomized trials with an active placebo (midazolam) show ketamine produces significantly greater and rapid PTSD symptom reduction.
  • Multiple observational cohorts and chart reviews report clinically meaningful improvements in PTSD symptoms with ketamine, including in treatment-resistant and comorbid populations.
  • Higher baseline PTSD symptom severity is repeatedly associated with greater improvement.
  • Combining ketamine with psychotherapy is a common and reportedly promising approach.
  • Ketamine is generally described as having a favorable or mild adverse-event profile in these studies.
Where do studies on ketamine for PTSD conflict?
  • A systematic review rates the evidence for ketamine in PTSD as very low to low, contrasting with the more encouraging conclusions of narrative reviews and observational studies.
  • One narrative review notes that ketamine in acute trauma care has been linked to heightened dissociation and stress symptoms, while clinical trials report no lasting dissociative effects.
  • Evidence quality ratings differ markedly across reviews, from 'encouraging signals' to 'very low' certainty.
What is still unknown about ketamine for PTSD?
  • Durability of benefit beyond a few weeks is not well established.
  • Most randomized evidence comes from very small samples (30-41 participants).
  • Blinding is difficult with psychoactive ketamine and an active placebo, and several included studies were unblinded or of poor quality.
  • Optimal dose, route (IV, IM, intranasal, oral, subcutaneous), and number of sessions are not established.
  • Long-term safety and risk of dissociation or maladaptive memory consolidation in acute trauma settings remain unclear.
  • Predictors of response beyond baseline severity are not well characterized.
How we analyze this

This synthesis reads the 15 most-cited and 10 most recent studies whose primary subject is Ketamine for PTSD, up to 25 in all. The most-cited set anchors the established evidence, and the recent set surfaces work that is too new to have gathered citations yet.

A study qualifies only when Ketamine for PTSD or a known alias appears in its title or keywords, so broad reviews that mention it only in passing are left out. Each study is read from its abstract, strongest evidence first, and the summary reports the direction of the results along with any conflicts and gaps.

The full method, including what a person does and does not review, is on the methods page.

Ask your own question in the Research Synthesis Tool

115 articles · 64 from the last two years · 31,601 participants across 68 studies reporting sample size

Common study designs

review 12 case study 5 animal study 6 systematic review 7 observational cohort 6

Research volume by year

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110 studies whose primary subject is ketamine for PTSD since 2014

Studies about ketamine for PTSD per year, 2014 to 2026, peaking at 37 in 2025 Bar chart: one bar per year, taller where more studies were published that year. 0 20 40 2015 2020 2025
2026 is partial
Show the numbers
Studies about ketamine for PTSD per year, 2014 to 2026, peaking at 37 in 2025
Year Studies
2014 1
2015 0
2016 0
2017 0
2018 2
2019 0
2020 2
2021 6
2022 13
2023 8
2024 19
2025 37
2026 22

Research

Synthesize the evidence →

Blood biomarker changes in response to low-dose oral ketamine treatment in adults with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD)

medRxiv August 14, 2026 Annette M Braxton, Christina Driver, Daniel F. Hermens et al. preprint

Abstract Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are prevalent, chronic, and disabling mental health conditions which are difficult to treat. Ketamine has demonstrated effect for improving depression and PTSD symptoms independently but reports often overlook focused comorbid improvement of these symptoms within individuals. To address this, we assessed...

DOI: 10.64898/2026.08.12.26360216 (opens in new tab) Full text (opens in new tab)

Psychedelic Therapies in the Management of Post-Traumatic Stress Disorder

Journal of Education Health and Sport July 16, 2026 Jakub Bajer, Aleksandra Włodarczyk, Hubert Kulawinek et al.

Background. Post-Traumatic Stress Disorder (PTSD) is an important public health challenge typically treated with trauma-focused psychotherapy and Selective Serotonin Reuptake Inhibitors (SSRIs). However, high rates of residual symptoms associated with these standard treatments have led to a renewed interest in psychedelic-assisted therapies. Aim. This review attempts to examine emerging...

DOI: 10.12775/jehs.2026.94.73071 (opens in new tab) Traumatic stress Ketamine Psilocybin Anxiety disorder +5

Ketamine effects on EEG and their links to therapy differ across treatment-resistant major depression, post-traumatic stress disorder, and obsessive-compulsive disorder

The International Journal of Neuropsychopharmacology July 6, 2026 Shabah M. Shadli, Neda Nasrollahi, Calvin K. Young et al.

BACKGROUND: Neurotic disorders - major depressive disorder (MDD), panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and specific phobia - have differing pharmaceutical profiles. But all, even when resistant to conventional treatment (TR), respond quickly to low dose (0.5-1.0 mg/kg I.M.) ketamine....

DOI: 10.1093/ijnp/pyag037 (opens in new tab) Full text (opens in new tab) Panic disorder Ketamine Anxiety disorder Major depressive disorder +11

Effect of esketamine-assisted regional block on post-traumatic stress disorder after radical lung cancer surgery: A retrospective clinical study

World Journal of Psychiatry June 19, 2026 Yan-Lin Chen, Tengchen Feng, Xiao-Min Zhang et al.

BACKGROUND Post-traumatic stress disorder (PTSD) is a common psychological complication after radical lung cancer surgery and has a significant impact on postoperative recovery and quality of life. Esketamine, a new anesthetic agent, may be protective against postoperative PTSD through modulation of neurotransmitter systems and anti-inflammatory actions. AIM To explore the underlying mechanisms...

DOI: 10.5498/wjp.v16.i6.119817 (opens in new tab) Full text (opens in new tab)

Ketamine-assisted psychotherapy for posttraumatic stress disorder: a systematic review and individual participant data meta-analysis of predictors of treatment effects.

Psychotherapy and Psychosomatics June 19, 2026 Judith Rohde, Tyler M Moore, Kathryn Walker et al.

Ketamine combined with psychotherapy has shown promise in treating posttraumatic stress disorder (PTSD), but predictors of clinical benefit remain unclear. In this systematic review and individual participant data meta-analysis (IPDMA), we examined patient- and treatment-level predictors of PTSD symptom change after combined treatment. Eligible studies combined ketamine with psychotherapy in...

DOI: 10.1159/000553144 (opens in new tab) Full text (opens in new tab)

At-Home Telehealth-Supported Subcutaneous Ketamine Therapy in Adults With Moderate to Severe Depression, Anxiety, or PTSD: A Real-World Observational Study of Safety, Feasibility, and Clinical Outcomes in a Large, Heterogeneous Cohort in the United States.

Journal of Medical Internet Research June 17, 2026 Acacia C Parks, Amanda L Woodward, Robert D Henry et al.

Background: Depression, anxiety,, and PTSD are leading global causes of disability. Standard interventions utilize slow mechanisms of action, high attrition, and significant accessibility barriers. While intravenous (IV) and intranasal ketamine are rapid-acting alternatives, high cost and intensive logistical requirements limit adoption. Sublingual (SL) at-home ketamine addresses some gaps but...

DOI: 10.2196/92647 (opens in new tab) Full text (opens in new tab)

Acute pretrauma ethanol exacerbates PTSD-like phenotype in rats and is reversed by early intranasal ketamine

Scientific Reports June 14, 2026 Bar Eilat Yogev, Gal Levi, Noa Efroni et al.

Alcohol consumption before trauma is a prevalent but understudied risk factor for posttraumatic stress disorder (PTSD). This study investigated whether acute ethanol exposure prior to trauma modulates PTSD-like symptom development in rats, identified hippocampal mechanisms involved, and tested an early post-trauma intervention. Adult male Sprague-Dawley rats received ethanol (1.6 g/kg, 40% v/v,...

DOI: 10.1038/s41598-026-56757-2 (opens in new tab) Full text (opens in new tab) Ketamine Nasal administration Ethanol Phenotype +4

Longitudinal Assessment of Ketamine-Assisted Community of Practice Therapy: A Retrospective 5-Year Study on Depression, Anxiety and PTSD

European Psychiatry June 1, 2026 A. Kuzma-Hunt, Z. Hamadeh, V. Tsang

Introduction Ketamine-assisted therapy shows rapid benefit in treatment-resistant depression, anxiety, and PTSD (Walsh et al. BJPsych Open 2022;8:e19). The Roots to Thrive Ketamine assisted Therapy (RTT-KaT) program is a unique 12-week program that combines 12 Community of Practice (group therapy) sessions and three ketamine medicine sessions (Tsang et al. Ther Adv Psychopharmacol...

DOI: 10.1192/j.eurpsy.2026.11732 (opens in new tab)

Clinical Outcomes of Ketamine Therapy for Depression, Anxiety, and PTSD in Post-TBI Patients

European Psychiatry June 1, 2026 W. Aldulaimy, A. Shah

Introduction TBI patients often suffer from severe, treatment-resistant depression and PTSD. Ketamine shows promise in non-TBI populations, but its efficacy in TBI patients needs exploration for efficacy and tolerability. Objectives Evaluate ketamine’s clinical effectiveness and safety (PHQ-9, GAD-7, PCL-5 scores) in post-TBI patients, comparing IM, intranasal, and oral routes. Methods Design:...

DOI: 10.1192/j.eurpsy.2026.11400 (opens in new tab)

The impact of ketamine on posttraumatic stress disorder (PTSD) symptomatology in trauma-exposed populations: a narrative review.

Journal of trauma and injury June 1, 2026 Minaal Ahmed Malik, Michele Halasa, Jack Chia et al.

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...

DOI: 10.20408/jti.2025.0086 (opens in new tab) Full text (opens in new tab) Ketamine Critical care Neurobiology Post-traumatic stress disorders

Clinical trials

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