Ketamine-Assisted Psychotherapy for Treatment- Resistant Depression with Comorbid Post-Traumatic Stress Disorder in Veterans

In an open-label naturalistic study, 27 Ukrainian veterans with treatment-resistant depression and PTSD symptoms received 1–4 ketamine infusions (0.5–1.0 mg/kg) paired with psychotherapy. Depression scores dropped significantly on the PHQ-9 and BDI (both p < .001, g = 1.20–1.31), and PTSD symptoms also decreased (PCL-M: p < .001, g = 1.10). Over half of participants achieved substantial improvement or remission, while 22–26% showed no change or slight worsening. Benefits lasted at least one month. No link was found between outcomes and age or therapist personality. The study adapted international guidelines for Ukraine's wartime context.

Study at a glance

Abstract

The aim of the study was to evaluate the practice of using ketamine-assisted psychotherapy (KAT) in accordance with international clinical guidelines at the State Institution "Center for Mental Health and Veterans' Rehabilitation 'Lisova Polyana' of the Ministry of Health of Ukraine" (Ukraine).Adapting the international clinical guidelines on ketamine therapy for treatmentresistant depression within the Ukrainian medical system in the context of war was the main focus of the study.Methods.The study had an openlabel, non-blinded naturalistic design with a single group of participants (n = 27).The sample included veterans with confirmed treatmentresistant depression (TRD) and PTSD symptoms.The KAT course consisted of 1-4 ketamine infusions at doses of 0.5-1.0mg/kg of body weight, accompanied by preparatory and integration psychotherapy sessions.Symptom dynamics were assessed using the "PHQ-9" (Kroenke et al., 2001), "BDI" (Beck et al., 1996), and "PCL-M" (Weathers et al., 1993) questionnaires.Psychodiagnostics were performed before treatment, after treatment, and one month after treatment.Nonparametric statistical methods (Wilcoxon signed-rank test, Spearman's correlation coefficient, Hedges' g) and correlational analysis were applied to explore relationships between outcomes and other variables.Results.The majority of participants demonstrated a significant reduction in depression symptoms (PHQ-9: p < .001,g = 1.31;BDI: p < .001,g = 1.20) and PTSD symptoms (PCL-M: p < .001,g = 1.10).More than 50.00% of participants achieved either substantial clinical improvement or remission.In 22.00-26.00% of participants, symptoms remained unchanged or slightly worsened, underscoring the need for an individualized treatment approach.The positive therapeutic effect persisted for at least one month after completion of treatment.While no correlation was found between KAT outcomes and participants' age or the therapist's personality,