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Ketamine for PTSD: the Science, Research & Psychology

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Ketamine Reduces PTSD Symptoms in Research

In 2014, a pioneering research paper, titled “Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder,” was published in the journal JAMA Psychiatry

Conducted by Dr. Adriana Feder, Dr. James Murrough, and Dr. Dennis Charney, from the Icahn School of Medicine at Mount Sinai, New York, the study was a randomized clinical trial comparing the short-term effects of IV ketamine with the placebo control midazolam. 

The study’s primary outcome was PTSD symptom severity, which was measured using the clinician-administered PTSD scale. Compared with midazolam, the participant’s symptoms significantly decreased after a single dose of ketamine.  

Following this proof-of-concept study, the research team then investigated the longer-term effects of ketamine infusions in PTSD patients. After six infusions of ketamine, spread over two weeks, they measured participant’s scores of PTSD and depression. Two weeks following completion of their treatment, the participants had significant reductions in symptoms.

During this study, the researchers also measured how the brain circuitry of patients changed from before to after treatment, measured using fMRI imaging. Their results were published in the journal Biological Psychiatry.

As well as infusions, other research teams are also investigating how repeated low doses of ketamine could help treat PTSD. 

Last year, an open-label proof-of-concept study led by Maud Rothärmel from the French Centre Hospitalier du Rouvray provided Esketamine, a low-dose nasal spray, to 11 patients with co-morbid depression and PTSD for six months. At the end of the study, Esketamine significantly reduced depression and suicidality scores on a rating scale compared to baseline.

In light of these positive research findings, the Veterans Administration (VA) has since partnered with Ketamine Wellness Centres (KWC), the largest ketamine provider in the US, to help war veterans with PTSD access this treatment financially. 

Concerns Around Ketamine’s Side Effects

intramuscular ketamine for ptsd

Ketamine was generally well tolerated in the 2014 Mount Sinai trial. However, researchers noted that one patient dropped out of the study due to dissociative effects. Moreover, three patients were treated with beta blockers due to increased blood pressure. 

Studies have also noted other dose-dependent risks associated with ketamine treatments, which include:

Laryngeal spasms (spasms of the vocal cord that make it difficult to breathe)
Respiratory depression (problems breathing that can increase the risk for coma, especially if combined with substances that act as CNS depressants, such as alcohol or opioids)
Chest pain
Amnesia (memory loss)

In addition, chronic abuse of ketamine is associated with severe urological problems and kidney toxicity. 

Altering the dose or route of administration is a means to help overcome some of these side effects.

For example, oral use of ketamine has a lower bioavailability, so administering it through this route will likely reduce the risk of side effects. However, whether or not repeated low doses of ketamine, taken intra-nasally or orally, are as effective as high-dose ketamine infusions remains unknown.

Although from a biomedical standpoint, the dissociative effects of ketamine may be considered undesirable, when supported and integrated within a psychotherapeutic structure, dissociation could be an essential part of the healing process. 

In line with this suggestion, ketamine-assisted psychotherapy research by Jennifer Dore and colleagues highlights that:

“No study to date has demonstrated that absent some degree of perceived psychoactivity, there is an antidepressant effect.”

Ketamine for PTSD and The Risk of Addiction

Another concern regarding ketamine for PTSD treatment is the risk of addiction.

Since ketamine has an addictive potential, and substance-use disorder (SUD) is often correlated with PTSD, a worry among clinicians is that PTSD survivors may turn to recreational ketamine as a means to self-soothe and search for symptomatic relief. 

However, like ketamine’s psychoactive side effects, addiction is a complex multidimensional disorder that includes contextual and behavioral components. 

For this reason, some of the same substances that have abuse potential (such as cannabis and ketamine) can also be used to help addicts overcome their dependencies within the clinical container.

Using Ketamine Infusions in Different Therapy Models

different therapy modalities

As more ketamine therapy clinics open up, the different treatment models being offered are becoming increasingly varied. 

One psychotherapeutic approach that demonstrated positive outcomes in a ketamine for racial-based trauma study was the Functional Analytic Psychotherapy (FAP) model. 

In this approach, therapists analyze the client’s behavior in a session to help understand their interpersonal behavior, emotional awareness, and self-expression. By deconstructing these elements with the patient and recognizing what doesn’t serve them, the open-minded state induced by ketamine can help patients make related perspective and behavior changes. 

However, since healing processes are non-linear and look different for everyone, there is no “one size fits all” model suited to everyone’s ketamine-based healing journey. 

Nonetheless, some concrete elements essential for healing take the form of mindfulness, gratitude for living in the present moment, and the prioritization of relationships that the individual feels have endured despite difficult times.

Recognizing the complex nature of trauma and treating PTSD, Numinus is one example of a clinic taking an integrative approach to holistic health. 

With a highly-qualified team of mental health specialists trained in various psychiatric, somatic, and mindfulness-based therapies, their treatments involve building a personalized approach that utilizes whatever therapy modality is necessary to help clients get to the roots of their trauma and manifest positive life change. 

Ketamine and PTSD: Final Thoughts

Psychedelics have forever changed the landscape of mental healthcare. 

In a new era of ketamine and other psychedelic therapies, treatment for PTSD is shifting from a standard medical approach to that which creates compassionate and safe breathing spaces for healing the intangible wounds of trauma. 

For more information about psychedelic-assisted therapy and finding a clinician near you, we recommend you visit the Numinus website.

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