Post-traumatic stress disorder varies greatly in its clinical and biological features, making treatment difficult. The largest randomized trial of ketamine for PTSD found no overall benefit over placebo, highlighting the need to identify which patients might respond. Using pre-treatment blood DNA methylation profiles and clinical data from that trial, machine learning models predicted treatment response. A model based on 1,208 methylation sites outperformed models using only clinical variables, and combining both data types improved accuracy further. The methylation-derived score identified responders with 92.9% accuracy. Predictive methylation sites were near genes involved in glutamatergic signaling, immune regulation, and known PTSD risk loci, suggesting peripheral DNA methylation patterns can guide precision pharmacotherapy for PTSD.
A scoping review of nine studies identified interventions for treating acute suicidality in emergency departments (EDs) that were tested between 2013 and 2023. Four studies tested a single dose of ketamine, three tested brief psychosocial interventions (two with follow-up care), and two tested motivational interviewing. The interventions with the strongest evidence and best fit for the ED environment were ketamine and Crisis Response Planning (CRP). However, the included studies had small sample sizes (average 57 participants), and there is currently insufficient evidence to conclude that these interventions are effective and well-suited for routine ED use. Further research is needed.