Examining the impact of comorbid posttraumatic stress disorder on ketamine's real-world effectiveness in treatment-resistant depression.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology – February 01, 2025
Source: PubMed
Summary
Ketamine offers new hope for people with hard-to-treat depression, even when complicated by post-traumatic stress. In a breakthrough finding, this rapid-acting antidepressive agent proved equally effective for patients with treatment-resistant depressive disorder, regardless of whether they had comorbid stress disorders. The treatment significantly reduced symptoms in both conditions.
Abstract
Depression with comorbid posttraumatic stress disorder (PTSD) is associated with more severe symptoms and a reduced response to traditional treatments. Although ketamine shows promise as a rapid-acting antidepressant for treatment-resistant depression (TRD), its effectiveness in patients with comorbid PTSD remains underexplored. Therefore, we conducted a retrospective analysis of 134 patients from the Canadian Rapid Treatment Center of Excellence to compare the effectiveness of four ketamine infusions (0.5-0.75 mg/kg) in reducing symptoms of depression and PTSD in TRD patients with and without comorbid PTSD. A repeated-measures linear mixed model was used to evaluate the impact of comorbid PTSD on ketamine's antidepressant effectiveness, measured by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Paired samples t-tests were used to assess changes in PTSD symptoms, measured by the PTSD Checklist for DSM-5 (PCL-5). We found a significant main effect of time on QIDS-SR16 scores, F(4, 209.32) = 36.67, p < 0.001, but no significant group-by-time interaction (p = 0.895), suggesting that comorbid PTSD did not impact the antidepressant effectiveness of ketamine. Significant improvements in PTSD symptoms were observed in overall PCL-5 scores, t(66) = 6.66, p < 0.001, and across all PCL-5 symptom clusters with moderate to large effect sizes. In a real-world sample of TRD patients, ketamine was effective in reducing symptoms of depression and PTSD, regardless of PTSD comorbidity. These findings highlight ketamine's potential as a novel intervention for a patient population that is frequently non-responders to conventional treatments. Future randomized controlled trials should explore mediating factors of improvement and long-term effects.