Examining the impact of comorbid posttraumatic stress disorder on ketamine's real-world effectiveness in treatment-resistant depression.
Danica E Johnson, Nelson B Rodrigues, Sydney Weisz, Noah Chisamore, Erica S Kaczmarek, David C J Chen-Li, Zoe Doyle, J Don Richardson, Rodrigo B Mansur, Roger S McIntyre, Joshua D Rosenblat
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology February 1, 2025 DOI: 10.1016/j.euroneuro.2024.11.008 via PubMed
Summary
AI-generated from the abstractDepression with co-occurring posttraumatic stress disorder (PTSD) leads to more severe symptoms and poorer response to standard treatments. In a retrospective analysis of 134 patients with treatment-resistant depression, four ketamine infusions (0.5-0.75 mg/kg) reduced depressive symptoms equally in those with and without comorbid PTSD; no significant group-by-time interaction was found. PTSD symptoms also significantly improved across all symptom clusters, with moderate to large effect sizes. Ketamine shows promise as an effective intervention for this hard-to-treat population, though future randomized trials should explore factors driving improvement and long-term outcomes.
Study at a glance
| Characteristics | Retrospective analysis Randomized Peer reviewed |
|---|---|
| Sample size | 134 |
| Population | Patients with treatment-resistant depression from the Canadian Rapid Treatment Center of Excellence |
| Intervention | Ketamine infusions |
| Dose | 0.5-0.75 mg/kg |
| Duration | Four ketamine infusions |
| Topics | Depression Ketamine |
| Keywords | Post-traumatic Stress disorders Treatment-resistant Depression treatment Ketamine treatment |
| Key finding | Ketamine reduced depressive symptoms in treatment-resistant depression patients regardless of comorbid PTSD, and also significantly improved PTSD symptoms. |
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.