The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence.

PTSD has few effective pharmacological treatments, and trauma-focused psychotherapies are limited by provider shortages and low patient engagement, often leading to chronic illness and reduced quality of life. Ketamine, an NMDA receptor antagonist already indicated for major depression with rapid antidepressant effects, shows transdiagnostic potential. A synthesis of clinical evidence—including case reports, chart reviews, open-label studies, and randomized trials—reveals high heterogeneity in presentation and treatment approach but encouraging signals of safety, efficacy, and durability. Future research directions are discussed.

Study at a glance

Abstract

Posttraumatic stress disorder (PTSD) is a devastating condition, for which there are few pharmacological agents, often with a delayed onset of action and poor efficacy. Trauma-focused psychotherapies are further limited by few trained providers and low patient engagement. This frequently results in disease chronicity as well as psychiatric and medical comorbidity, with considerable negative impact on quality of life. As such, off-label interventions are commonly used for PTSD, particularly in chronic refractory cases. Ketamine, an N-methyl-D-aspartate (NDMA) receptor antagonist, has recently been indicated for major depression, exhibiting rapid and robust antidepressant effects. It also shows transdiagnostic potential for an array of psychiatric disorders. Here, we synthesize clinical evidence on ketamine in PTSD, spanning case reports, chart reviews, open-label studies, and randomized trials. Overall, there is high heterogeneity in clinical presentation and pharmacological approach, yet encouraging signals of therapeutic safety, efficacy, and durability. Avenues for future research are discussed.