Some experts believe ketamine provides fast-acting, effective, and lasting benefits for people with PTSD, but research has produced mixed results. While some studies show significant improvements in PTSD after ketamine treatment, others show minimal effects, and some even show a worsening of PTSD symptoms. Ketamine seems to be more effective in treating chronic forms of PTSD like cPTSD than in treating newly diagnosed individuals.1, 2, 3, 4
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What Is Ketamine Therapy?
Ketamine therapy, or ketamine-assisted therapy, involves therapy combined with periodic doses of ketamine. Historically, ketamine was developed in 1970 as an alternative to general anesthesia, but it was FDA-approved as a breakthrough treatment for depression in 2019.1, 2, 4 Now, researchers are investigating whether it can be used to treat other mental illnesses, including PTSD. Because the use of ketamine as a mental health treatment only began a few years ago, more research is needed to understand the potential risks and benefits fully.5
Because ketamine is a dissociative anesthetic with some hallucinogenic effects, the use of ketamine in mental health falls under the category of psychedelic therapy, which involves therapy sessions conducted while a person is under the influence of a psychedelic drug. One of the major potential advantages of psychedelic treatments like ketamine is that they can work much faster than traditional treatments, sometimes producing effects after just a few sessions.6
Is Ketamine Therapy Legal?
Ketamine is a controlled prescription drug, and like all controlled drugs, ketamine is an addictive drug. It has a history of being abused for recreational purposes and has also been used as a date rape drug because of its dissociative effects. Like all scheduled and controlled medications, ketamine is illegal to have or use unless a person has a valid prescription. When ketamine is administered in clinical settings to patients receiving ketamine-assisted therapy, it is completely legal.4, 7, 8
How Can Ketamine Help With PTSD?
Ketamine is a drug that works on NMDA receptors and glutamate and BNDF levels in the brain, which are known to play a key role in posttraumatic stress disorder (PTSD). Loss of synaptic connections in the hippocampus has been linked to PTSD, and it’s been theorized that these are triggered by overwhelming stress and trauma. While scientists don’t know for sure, many believe that ketamine works by helping to prevent or repair a loss of synaptic connectivity in the brain after a traumatic event.1, 2, 3, 4
Interestingly, this same theory that ketamine works on chemicals in the brain responsible for wiring synapses may also explain why ketamine therapy for PTSD sometimes backfires, making symptoms worse. When ketamine is administered too soon after a traumatic event, it may cause too much excitement in the synapses in the hippocampus, leading to worsened anxiety, avoidance, and dissociative flashbacks.1, 3, 4
Other theories about how and why ketamine is effective for certain mental illnesses include the neuroplasticity theory, which suggests the drug might help the brain wire and rewire connections. Neuroplasticity is a front-running theory on how other psychedelic drugs like psilocybin work, suggesting that these drugs can make the brain more ‘plastic’ or changeable. Others speculate that ketamine’s anti-inflammatory effects could also contribute to its mental health benefits.6
How Can Ketamine Help With CPTSD?
Interestingly, there is some research that suggests ketamine may be more effective as a treatment for complex PTSD (CPTSD) than it is for PTSD. Complex PTSD is normally linked to old, unresolved trauma from childhood and the symptoms tend to be more chronic and harder to treat. Studies on ketamine therapy found much better results and fewer side effects when using this treatment for individuals with CPTSD compared to people with more recent onset of PTSD symptoms.4
Can Ketamine Effectively Treat PTSD?
At this time, there is not enough research to prove that ketamine is an effective treatment for post-traumatic stress disorder. In studies, some people appear to respond positively to ketamine treatment, others have a minimal response, and others respond negatively to the treatment. Researchers are still working to understand why ketamine provokes such varied responses in people with PTSD and what factors make the biggest difference.1, 3, 4
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The timing of the ketamine administration does appear to make a difference, according to multiple studies. Some studies administered ketamine prior to a stressful or traumatic event to see if the drug would help prevent PTSD, with one study reporting significant decreases in the ketamine-treated group.3, 9 Another study found that when ketamine was given right after a traumatic event, it seemed to interfere and worsen people’s symptoms.4
Ketamine trials that were most effective for symptoms of PTSD tended to involve patients who had more chronic forms of PTSD, which are often traced back to childhood traumas. While classic PTSD involves symptoms of intense anxiety, CPTSD symptoms more often mimic the symptoms of depression (i.e., low self-esteem and negative thoughts). There’s much more robust evidence of ketamine’s antidepressant effects, which may help to explain why this treatment works better for CPTSD than PTSD.10, 11
How Fast Does Ketamine Work for PTSD?
Generally speaking, psychedelic therapies like ketamine-assisted treatment work faster than traditional talk therapy or trauma therapy approaches. In some cases, people receiving ketamine treatment report dramatic improvements after just 1-3 treatments. Other times, the progress is slower, more subtle, or sometimes doesn’t happen at all. There are also a number of instances where PTSD symptoms improve directly after taking ketamine, but then return within 1-2 weeks.3, 4, 5, 9
There are many different variables that affect how quickly a treatment works for someone, including:1, 3, 4, 6, 9
- Their symptoms: People who recently experienced a traumatic event & developed symptoms of PTSD may not respond well to ketamine-assisted therapy, and symptoms may worsen
- The drug formulation: There are different formulations of ketamine offered in ketamine-assisted treatment (IV and nasal spray), and some research suggests that IV-administered ketamine works faster & better than the nasal spray S-Ketamine formulation
- Individual response & interactions: Most studies of ketamine therapy had a 2-week ‘washout’ period to detox the system from any and all prescribed and illicit medications, as ketamine can interact with certain prescribed medications (like antidepressants)
- The treatment plan: Each clinic providing ketamine therapy has a different set of policies and protocols, including whether the ketamine is assisted in the clinic or at home, specific dosing and frequency guidelines, and whether therapy sessions are included or offered separately
- The provider: Ketamine therapy is a novel treatment, and there is not yet a standardized process for becoming credentialed or approved as a ketamine-assisted therapy provider, meaning it’s a good idea to do research before selecting a provider
- The set & setting: The set and setting of ketamine treatment is an important part of treatment that can affect whether or not it works, as psychedelics make you more sensitive to sights, sounds, smells, and objects, and people around you
- Their personal history: Consult with your provider if you experienced a recent traumatic event, or if your PTSD symptoms began within the last 90 days, as there’s some research to suggest ketamine may worsen symptoms in acute or recent PTSD diagnoses
- Their treatment history: Since ketamine isn’t an FDA-approved treatment for PTSD, it’s a good idea to begin with a frontline, proven trauma treatment like CPT, ART, EMDR, or TF-CBT (for kids/teens)
Is Ketamine a First or Last Resort for PTSD Treatment?
Ketamine is not an FDA-approved treatment for PTSD, and there is not enough evidence yet to convincingly prove it will help people struggling with PTSD symptoms. This could change in the future, but right now, there are a number of other preferred frontline PTSD treatments that have a lot more evidence to suggest they work.4, 5, 7
Ketamine vs. Psilocybin for PTSD
Ketamine is considered a form of psychedelic therapy, even though it is not technically a psychedelic drug. Unlike other psychedelics like LSD and psilocybin, people who receive ketamine treatment rarely experience any hallucinations or other typical distortions of perception associated with psychedelic drugs. The effects of ketamine are also much shorter, with peak effects lasting only 2-3 hours instead of the 6-8 hours of effects after taking psilocybin.4, 8, 11
Overall, there is stronger evidence for the use of psilocybin in PTSD treatment than there is for ketamine. For most people reading this article, psilocybin therapy is not an option since it is illegal and only offered for a small number of individuals who are enrolled in an active research trial. Ketamine treatment, on the other hand, is becoming more widely available around the US after being FDA approved. While there is strong evidence that ketamine helps people with treatment-resistant depression, the evidence it can help people with PTSD is much weaker.1, 3, 10
How Long Do the Benefits of Ketamine for PTSD Last?
The psychoactive effects of ketamine last for about 2-3 hours per dosage, but the drug remains in your system for three days a week.7, 8 In studies, the most significant positive effects were usually noted directly after a person received a dose, and seemed to dwindle for many in the days afterward. Unlike other forms of psychedelic therapy, it appears that ketamine does not offer the same sort of lasting results for everyone.1, 3, 4
In the trials testing the use of ketamine for PTSD, it was fairly common for participants to report that after 1-2 weeks, their symptoms returned. Only a few studies reported consistent, lasting results, and most of these were in people who experienced more depressive or CPTSD symptoms.3, 4, 10 While most ketamine-assisted therapy clinics offer packages of 6-8 sessions or more, it’s not uncommon for people to report that the benefits of ketamine treatment didn’t last, and that their symptoms returned within a week or two.3, 4
Stages of Ketamine Therapy for PTSD
Because ketamine-assisted therapy is new, there is no standard protocol clinics use for this treatment, and no ‘stages of treatment’ have been universally recommended or adopted. Depending on which clinic you contact, you might hear very different descriptions of what treatment includes, what it looks like, how long it lasts, and how many sessions are typically recommended.
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Does PTSD Qualify Me for Ketamine Therapy?
Because ketamine is not an FDA-approved treatment for PTSD, it may not be possible to receive this treatment if you only have a diagnosis of PTSD. Ketamine is currently only FDA-approved for treatment-resistant depression, and many clinics providing the treatment have a screening process to determine eligibility. It’s likely that people who are seeking treatment for PTSD would be screened out during this process, and referred to an approved PTSD treatment.7, 8
Still, research suggests that 80% of people who are diagnosed with PTSD have at least one other mental health diagnosis. Depression is one of the most common types of mental health disorders in the United States, and often co-occurs with posttraumatic stress disorder. Some people who are diagnosed with both PTSD and depression may be good candidates for ketamine therapy.1, 2
What To Expect During Ketamine Treatment
If you are approved to receive ketamine-assisted therapy, it can help to know a little more about this treatment and what to expect. As outlined earlier in this article, ketamine is a new and novel mental health treatment, and protocols and standards are still being developed. Because of this, your experience can be very different depending on where you choose to receive care. For example, there are some clinics that provide medication only and others that offer a combination of medication and individual or group therapy.6
Most clinics require you to come on-site for your ketamine doses (with someone to drive you home after) but there are reports of some that will mail the ketamine to your home after you pass through the screening phase. According to FDA guidelines, ketamine should be administered in a facility with licensed medical and mental health providers who can supervise you for at least two hours after taking the medication.7, 12
How is Ketamine for PTSD Administered?
Ketamine can be administered as a nasal spray or an intravenous drug. The nasal spray of esketamine is a slightly different formulation than the intravenous ‘racenic’ form.7, 12 According to some research, the IV racemic form of ketamine is more effective, providing results that are faster-acting and more effective.4, 6, 7
While there are some clinics that offer at-home ketamine administration (self-administered), most require patients to come to a facility for each dose. Normally, ketamine treatment for PTSD involves multiple sessions spaced 3-7 days apart. Many clinics offer package deals of 6-8 sessions or more. Depending on the clinic, there may be protocols in place to track patient progress, adjust dosages, and shorten or lengthen the timeline of treatment.6, 12
Dosages of Ketamine for PTSD
The brand name of the ketamine formulation most often used in mental health treatment is Spravato, which is the nasal spray version of the drug. According to the dosage guidelines, Spravato recommends a starting dose of 56 mg administered in a single nasal spray for the first 1-4 weeks of treatment. Normally, doses are given twice a week, and are spaced at least a few days apart.6, 7, 12
After a patient tolerates this well, the dosage may be increased up to 84 mg per dose, which is usually given 1-2 times per week for the remainder of treatment. Depending on how the person’s symptoms respond to the treatment, the dose and frequency can be adjusted. Many people begin with twice-weekly doses and drop down to weekly or every other week until the desired results are achieved.6, 7, 12
Effects of Ketamine for PTSD
Most people who have taken esketamine (the most common formulation offered) describe that the drug makes them feel lighter, happier, and more relaxed. Some describe feeling slightly disoriented and foggy, and this can sometimes trigger or worsen symptoms of anxiety. Most people do not report having any hallucinations, but do feel like their senses are enhanced for the 2-3 hour period the drug is most active.6, 7, 8, 12
There are some people who experience side effects from ketamine. Most commonly, these happen during the 1-3 hours of the peak effects. The most common side effects are nausea, dizziness, headaches, high blood pressure and impaired vision, coordination, and thinking. Most of the time, these side effects are short-lived and resolve shortly after the drug wears off but for some, they can linger for a day or longer. The risk for these adverse effects is higher when people take larger doses of the drug.1, 2, 3, 7
At higher doses, some people also experience dissociative episodes, which can complicate or worsen PTSD symptoms like flashbacks. Less commonly, people describe feeling stimulating effects after taking ketamine, including restlessness, agitation, or heart palpitations. Ketamine also has depressant effects, which can result in respiratory depression in rare but serious cases. This risk is higher when ketamine is mixed with other depressants like alcohol, opioids, or benzodiazepines.7, 8, 12
Is Ketamine Therapy for PTSD Safe?
Overall, the esketamine formula used in mental health treatment is considered safe, and most side effects are mild and transient in nature, resolving on their own within hours. All FDA-approved medications go through a rigorous testing process to ensure they are effective and safe, and ketamine has been an approved drug for over 50 years. While ketamine has passed the safety test, it still has not passed the efficacy test to become an approved treatment for PTSD.1, 4, 7, 8
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In order to become FDA-approved as a treatment for PTSD, additional studies would need to prove that the drug is more effective than a placebo, and comparable in effects to other approved treatments. This research is underway, and it’s possible that ketamine could become an approved PTSD medication in the near future, but it hasn’t happened yet. Because the previous studies have provided mixed results with some patients reporting a worsening of symptoms, it’s important to approach this off-label PTSD treatment with a healthy degree of caution.5, 7
Can Ketamine Treatment Be Addictive?
Ketamine is a controlled schedule 3 drug under the DEA, which means it has a low to moderate potential for abuse and addiction. Most people who become addicted to ketamine are abusing the drug recreationally. Because most ketamine clinics have strict guidelines about the dosage and schedule of treatments (i.e., spacing treatments 3-7 days apart), it is highly unlikely that someone receiving ketamine-assisted therapy for PTSD or depression would become addicted.(FDA, DEA)
Risks & Precautions of Ketamine Therapy for PTSD
All medications carry some degree of risk. Some of the risks can be predicted based on information about side effects reported in the drug trials, and some cannot. Each person has a different biological, psychologic, and neurologic make-up that will determine how they respond to a certain drug. Newer drugs are often riskier because there is less data about the short and long-term side effects and risks.
While ketamine has been FDA-approved for over half a century, it has only been used in mental health treatment for a few years, and more information is emerging all the time from current research and trials. According to the currently available data, here are some of the most likely risks associated with ketamine therapy for PTSD:6, 7, 8, 12
- Non-response: Approximately 1-2% of people who take ketamine will not respond to the drug, reporting no psychoactive effects or benefits
- Worsened PTSD symptoms: increased flashbacks, nightmares, trauma memories, anxiety and avoidance of triggers can occur for some people (esp. w/ recent trauma)
- Physical anxiety symptoms: feeling restless, anxious, confused, and having heart palpitations or high blood pressure
- Physical discomfort & pain: Dry mouth, headaches, and blurred vision can occur, but nausea and vomiting are the most common side effects reported
- Dissociative symptoms: increased flashbacks, re-living traumatic memories, or having out-of-body experiences
- Confusion & cognitive difficulties: feeling disoriented, confused, foggy, unable to think or process information clearly, memory problems or trouble concentrating
- Relapse of symptoms: experiencing a return of symptoms or worsening of symptoms 1-2 weeks after the last dose
- Addiction & dependence: ketamine is an addictive substance, and is more likely to be addictive when it’s abused or taken in high doses or too frequently
- Respiratory depression: respiratory depression is a risk associated with most drugs that are CNS depressants, and is more likely to occur when taking many depressant drugs at once
- Negative drug interactions: ketamine can interact and interfere with other drugs and medications, including common antidepressants
Who May Not Be A Good Fit for Ketamine Treatment?
Ketamine is only recommended for individuals that have a diagnosis of treatment-resistant depression. Most of the time, ketamine-assisted therapy is only recommended for depression when other frontline treatments like therapy and SSRI antidepressants have not helped. There are a number of different exclusion criteria that can disqualify someone from receiving ketamine treatment. Some are standard and others will be specific to a certain clinic offering the treatment.6
Common exclusion criteria that may mean you are not a good candidate for ketamine treatment include:6, 7
- People with cardiovascular disorders such as arrhythmias
- People with a history of hemorrhage, lesions, tumors or swelling
- People with a history of adverse or allergic reactions to ketamine
- People with unmanaged high blood pressure
- People with an active, unmanaged substance use disorder or addiction
- People with a history of schizophrenia or psychosis
- People with an unmanaged dissociative disorder
- People with unmanaged thyroid disorder or disease
- People who are pregnant, breastfeeding, or trying to become pregnant
- People with severe forms of PTSD and recent unprocessed traumatic experiences
- People with severe and unmanaged Obsessive Compulsive Disorder (OCD)
Ketamine as a Standalone Treatment for PTSD
Psychiatric medications are most effective when combined with psychotherapy, and there is no evidence that ketamine is effective as a standalone treatment for PTSD. People who are interested in this treatment should look for a qualified trauma therapist to assist them in this treatment. This helps to ensure people get the most out of treatment, and also is important to help them adequately prepare for sessions, learn effective coping skills, and have someone there to help them reprocess difficult memories and feelings that may emerge.6, 7
Dr. Sara Koenig, owner and medical director of Triangle Wellness and Recovery PLLC in Raleigh offers ketamine in her clinic and agrees, saying, “I get concerned about people who carry trauma receiving ketamine assisted psychotherapy in a purely medical setting. Frankly – I think that’s dangerous because the potential for retraumatization is a real concern. In my practice we only offer KAP for PTSD and cPTSD, ketamine alone isn’t even an option.” Most ketamine clinics have similar policies in place that require someone to take part in therapy sessions at the facility, or they may partner with other clinicians in the area to provide the therapy component of treatment.
Is Ketamine Therapy Right for You?
Ketamine is not an FDA-approved treatment for PTSD, so it will be difficult to find this treatment option unless you have a diagnosis of depression.5, 7 For those who have co-occurring PTSD and depression or those suffering with symptoms of CPTSD, ketamine may be an option. If it is an option, it is still only one of several treatment options that should be considered and weighed according to the potential risks and benefits.
Before signing up for ketamine-assisted therapy, there are many factors to consider, including the symptoms you’re trying to treat and your expectations going into treatment. A lot of people mistakenly believe ketamine and other psychedelic therapies are ‘magic cures’ for mental illnesses – they are not. In some cases, these powerful drugs can even psychologically destabilize a person in ways that make their symptoms worse.7
The best way to determine if ketamine treatment is right for you is to speak with a licensed medical or mental health provider who is familiar with this treatment. Many clinics offer free consultations or informational sessions to answer frequently asked questions about the treatments they offer, which can be a great way to learn more and make an informed decision about treatment. It’s always important to schedule an appointment with your primary care doctors and those who prescribe your medications before starting a new drug or treatment.
How to Find a Ketamine Therapist for PTSD
Finding a ketamine clinic near you is often as easy as doing a search online to make a list of providers near you. If you live in a rural area, ketamine-assisted therapy may not be an option yet, and the nearest clinic could be several hours away. After making a list of clinics near you that offer ketamine treatment, the next step is to make some phone calls to schedule consultations. Many clinics offer these at no charge. During a consultation call, you can ask more questions about the cost, structure, and length of treatment.
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It’s also a good idea to ask whether the clinic offers ketamine as a standalone treatment or as a part of a larger treatment that includes group or individual therapy, since you may need to find a separate therapist. Dr. Sara Koenig emphasizes that “Ketamine-assisted psychotherapy requires a strong foundational therapeutic alliance between the client and therapist, as well as trust between the client and medical provider”. Using an online therapist directory can be a great starting point to find a therapist, and a free consultation is a good way to screen out therapists who aren’t a good match.
Cost of Ketamine Treatment for PTSD
The cost of ketamine-assisted therapy varies based on where you live and what kinds of services are included at a specific clinic. Sometimes, the cost of medication and/or therapy can be partially covered by insurance, depending on the details of your policy and whether the clinic is in-network or not. Calling around to different clinics is the best way to inquire about costs. If the clinic accepts your insurance, the next step would be to call the number on the back of your insurance card to get a more detailed breakdown of the final out-of-pocket costs.
Alternative Treatment Options for PTSD
Alternative PTSD treatment options do exist, including several that have a lot more evidence to suggest they can help people struggling with post-traumatic stress disorder. These include Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), and Accelerated Resolution Therapy, which are all evidence-based treatments for PTSD. There are also a couple of FDA approved medications used in the treatment of PTSD: the SSRI drugs sertraline and paroxetine. All of these treatments should be considered prior to Ketamine for PTSD, since they have been more thoroughly researched and vetted.4, 5
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