July 15, 2022

Ketamine for PTSD


Ketamine for PTSD

What is Ketamine?

Ketamine is a dissociative anesthetic used in hospitals around the world every day. Ketamine is approved by the U.S. Food and Drug Administration (FDA) for the induction and maintenance of anesthesia, although it is also used for the management of psychiatric disorders and chronic pain management. Ketamine has been incorporated into the treatment of psychiatric disorders, such as major depressive disorder (MDD), bipolar disorder, and post-traumatic stress disorder (PTSD), as well as post-operative and chronic pain management.  Please note that esketamine nasal spray, a derivative of ketamine, has been separately approved by the FDA for treatment-resistant depression.

How is it used?

Ketamine can be administered intravenously (IV), inhaled (nasal spray) or ingested (troches/lozenges).  With an IV infusion the impacts of Ketamine can be felt in one minute, 5–15 minutes if inhaled, and around 10 minutes if eaten. Its effects can persist for around an hour, although it can influence a person's coordination or perceptions for up to 8 hours after first using it.

How does Ketamine work?

Ketamine is an FDA-approved anesthetic agent that has been found to produce rapid and potent antidepressant effects in individuals with severe depression, anxiety, chronic pain and PTSD. Ketamine also has anti-inflammatory effects. Studies show that ketamine potentially operates by encouraging the regeneration of certain neural connections. Researchers believe that chronic stress or trauma can cause the death of specific neurons, resulting in depression.

Ketamine can activate a brain circuit associated with resilience and stress resistance. Ketamine is an antagonist of the NMDA (N-methyl-D-aspartate) receptor, one type of receptor for glutamate, the major excitatory amino acid in the brain. Glutamate is a neurotransmitter with a wide range of effects across the neurological system. At normal concentrations, glutamate is crucial for brain functions. However, at high concentrations the increased cellular activity caused by glutamate results in over-excitation of nerve cells, which eventually leads to cell death. This neurotransmitter's overactivity can result in depression symptoms. When Ketamine suppresses this neurotransmitter, the glutamate neurotransmission route is restored, which helps to alleviate depression.

Ketamine has the potential to repair neurons within hours, which helps to alleviate PTSD symptoms. Ketamine works very well on the parts of the brain that deal with emotions and long-term memory.


Relation of PTSD and Ketamine

Although daily use of SSRIs and SNRIs to start treating PTSD symptoms, ketamine therapy can provide relief quickly. Most patients will see positive results after one ketamine treatment in relation to their PTSD.  Typically the treatment protocol is prescribed with a series of 6-12 sessions spread over 8-12 weeks.

PTSD

There is mounting evidence for a role of the excitatory neurotransmitter glutamate in stress responsiveness, the formation of traumatic memories, and the pathophysiology of PTSD, raising the possibility of identifying novel glutamatergic interventions for this disorder.

Ketamine has shown promising results in alleviating the symptoms of several anxiety disorders, including general anxiety disorder (GAD) and post-traumatic stress disorder (PTSD). After Better U's at-home ketamine treatments, clients report reduced anxiety within an hour, with effects lasting up to fourteen following a single dosage. Ketamine can be administered at weekly intervals as a form of “maintenance dosing.” Eighteen out of twenty patients with GAD reported continuous improvement in social and work functioning during this maintenance period. These results persisted for up to fourteen weeks. Ketamine has also shown to be effective in rapidly and significantly reducing severity of symptoms among patients with PTSD. It is believed that this efficacy is due to Ketamine targeting and reconsolidating memories of traumatic experiences. This allows the brain to basically expel this trauma rather than retaining it, which can lead to dysfunctional patterns of thought and behavior.

What role does Ketamine therapy play in your PTSD treatment?

Although the past cannot be changed, we may be able to create a new empowering meaning behind it.  Ketamine can be the transformational tool to create a meaning behind the story that is held in the mind by seeing things in a new way.  This results in a paradigm mental shift and accordingly new beliefs and actions surrounding the trauma.  

You may be using medications, cognitive behavioral therapy, or a mix of both to treat post-traumatic stress disorder. Ketamine therapy may help you relax and clear your brain as well as alleviate symptoms caused by PTSD. If you are suffering from PTSD, a ketamine prescription and treatment protocol can help reduce PTSD symptoms and provide mental clarity.

If you feel you have PTSD or know someone with PTSD, a mental health professional that has experience detecting and treating the disease should treat you.

References:

  1. Berman RM, Cappiello A, Anand A, Oren D a, Heninger GR, Charney DS, et al. Antidepressant effects of ketamine in depressed patients. Soc Biol Psychiatry. 2000;47(4):351–4.
  2. Moghaddam B, Krystal J.H. (2012) Capturing the angel in angel dust: twenty years of translational neuroscience studies of NMDA receptors antagonists in animals and humans. Schizophr Bull. 2012 Sep;38(5):942-9.
  3. Zarate CA, Singh JB, Carlson PJ, Brutsche NE, Ameli R, Luckenbaugh DA, et al. A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Arch Gen Psychiatry [Internet]. 2006;63(8):856.
  4. Duman RS, Aghajanian GK. Synaptic dysfunction in depression: potential therapeutic targets. Science [Internet]. 2012;338(6103):68–72.
  5. Li N, Lee B, Liu R-J, Banasr M, Dwyer JM, Iwata M, et al. mTOR-Dependent Synapse Formation Underlies the Rapid Antidepressant Effects of NMDA Antagonists. Science (80- ) [Internet]. 2010;329(5994):959–64.


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