MacConnel Henry A, Earleywine Mitch, Radowitz Steven
Department of Psychiatry, Mount Sinai Hospital, New York, NY, USA.
Department of Psychology, University at Albany, Albany, NY, USA.
J Psychopharmacol. 2025 Jan;39(1):29-37. doi: 10.1177/02698811241286726. Epub 2024 Oct 14.
Traditional treatments for post-traumatic stress disorder (PTSD) often show limited success with high dropout. Ketamine, an -methyl-D-aspartate antagonist known for rapid antidepressant effects, has decreased PTSD symptoms in some studies but not in others. Administering ketamine in ways that parallel psychedelic-assisted treatments-including preparatory, integration, sensory immersion, and psychotherapy sessions-could decrease PTSD symptoms meaningfully.
A retrospective sample of 117 screened outpatients with elevated PTSD Checklist for DSM-5 (PCL-5) scores received intravenous ketamine in supportive environments. The protocol included preparation, intention-setting, and integration sessions accompanying at least six administrations. Administration sessions included eye shades and evocative music paralleling typical psychedelic therapy trials.
Mean PCL scores decreased from 52.54 (SD = 12.01) to 28.78 (SD = 16.61), = 1.64. Patients tolerated treatment well, with no serious adverse events. Covariates, including age, gender, days between PCL assessments, number of psychiatric medications, and suicidal ideation were not significant moderators; concomitant psychotherapy did reach significance, = 0.51. Of the 117 patients' final PCL scores, 88 (75.21%) measures suggested clinically meaningful improvement and 72 (61.54%) suggested remission of PTSD symptoms.
Intravenous ketamine in supportive environments, with hallmarks of psychedelic therapy, preceded large reductions in PTSD symptoms. These results highlight ketamine's potential when delivered in this manner, suggesting environmental factors might account for some variation seen in previous work. Given the molecule's cost, minimal interaction with other psychiatric medications, and legal status, intravenous ketamine in a psychedelic paradigm may be a promising option for PTSD unresponsive to other treatments.
创伤后应激障碍（PTSD）的传统治疗方法往往成效有限，且退出率高。氯胺酮是一种以快速抗抑郁作用而闻名的N-甲基-D-天冬氨酸拮抗剂，在一些研究中可减轻PTSD症状，但在其他研究中则不然。以类似于迷幻辅助治疗的方式使用氯胺酮，包括准备、整合、感官沉浸和心理治疗环节，可能会显著减轻PTSD症状。
对117名筛选出的门诊患者进行回顾性研究，这些患者的DSM-5创伤后应激障碍检查表（PCL-5）得分升高，在支持性环境中接受静脉注射氯胺酮治疗。治疗方案包括准备、设定意图和整合环节，且至少伴随六次给药。给药环节包括使用眼罩和播放唤起情感的音乐，类似于典型的迷幻疗法试验。
PCL平均得分从52.54（标准差=12.01）降至28.78（标准差=16.61），t=1.64。患者对治疗耐受性良好，未出现严重不良事件。协变量，包括年龄、性别、PCL评估之间的天数、精神科药物数量和自杀意念，均不是显著的调节因素；同时进行的心理治疗确实具有显著性，r=0.51。在117名患者最后的PCL得分中，88项（75.21%）显示出临床上有意义的改善，72项（61.54%）表明PTSD症状缓解。
在支持性环境中静脉注射氯胺酮，并具有迷幻疗法的特点，可使PTSD症状大幅减轻。这些结果凸显了以这种方式使用氯胺酮的潜力，表明环境因素可能是先前研究中观察到的一些差异的原因。鉴于该药物的成本、与其他精神科药物的相互作用最小以及法律地位，迷幻范式下的静脉注射氯胺酮可能是对其他治疗无反应的PTSD的一种有前景的选择。
