Ketamine for PTSD
Ketamine represents a groundbreaking advancement in post-traumatic stress disorder (PTSD) treatment, offering a viable treatment alternative to individuals who have not responded adequately to conventional therapies. Originally developed as an anesthetic, ketamine’s unique mechanism of action as an N-methyl-D-aspartate (NMDA) receptor antagonist has revealed its potential to rapidly alleviate symptoms of treatment-resistant PTSD. Unlike traditional medications that may take weeks to alleviate PTSD symptoms, ketamine often produces noticeable improvements within hours to days of administration.
The medication works by blocking NMDA receptors in the brain, which leads to increased production of brain-derived neurotrophic factor (BDNF) and promotes neuroplasticity. This is the brain’s ability to form new neural connections. This neuroplastic response appears to help “reset” dysfunctional neural pathways associated with traumatic events, allowing patients to process traumatic memories more effectively and experience significant symptom relief. For many individuals with PTSD, ketamine therapy has provided the breakthrough needed to engage more successfully with psychotherapy and rebuild their quality of life.
To learn more about how ketamine may be used to treat PTSD, contact Balanced Mind of New York for a complimentary 15-minute consultation.
What Is PTSD?
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that develops following exposure to or witnessing a traumatic event such as combat, sexual assault, accidents, natural disasters, or other life-threatening situations. The disorder affects approximately 3.5% of adults in the United States annually, with women being twice as likely as men to develop PTSD. Symptoms typically emerge within one month of the traumatic event but can appear months or even years later.
A structured clinical interview, usually by a licensed psychotherapist, is completed to evaluate a person for a PTSD diagnosis. PTSD is characterized by four main symptom clusters: intrusive memories (flashbacks, nightmares, distressing thoughts), avoidance behaviors (avoiding trauma-related triggers, people, or places), negative alterations in mood and cognition (persistent negative beliefs, emotional numbing, memory problems), and alterations in arousal and reactivity (hypervigilance, exaggerated startle response, sleep disturbances, irritability). These symptoms significantly impair daily functioning, relationships, and overall quality of life. Traditional treatments include trauma-focused psychotherapies like Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT), along with medications such as selective serotonin reuptake inhibitors (SSRIs), though many patients continue to experience persistent symptoms despite these interventions.
Can Ketamine Therapy Help With Complex PTSD?
Ketamine therapy has emerged as a promising treatment option for individuals with complex PTSD (C-PTSD), offering hope for those who have not responded well to traditional therapies. Unlike conventional antidepressants that work on serotonin pathways, ketamine acts as an NMDA receptor antagonist, rapidly promoting neuroplasticity and the formation of new neural connections in the brain. This mechanism can help break the cycle of persistent trauma responses and negative thought patterns characteristic of C-PTSD. Research suggests that ketamine therapy may provide rapid relief from symptoms such as severe depression, anxiety, dissociation, and suicidal ideation that often accompany complex trauma.
What Are the Methods of Ketamine Administration?
Ketamine can be administered through several different routes, each offering distinct advantages and considerations for treating PTSD. The choice of administration method depends on factors including patient preferences, clinical setting, treatment goals, and individual response patterns. Each method has different onset times, duration of effects, and monitoring requirements, making it essential for clinicians to understand the nuances of each approach.
The four primary methods of ketamine administration for PTSD include intravenous infusion, intramuscular injection, intranasal spray, and sublingual tablets or lozenges. Intravenous ketamine (ketamine infusion) is considered the most effective type of administration due to its precise dosing control and extensive research backing, while newer formulations like intranasal Spravato offer greater convenience and accessibility.
Ketamine Infusions (Intravenous Ketamine)
Intravenous ketamine infusions represent the most studied and widely accepted method of ketamine administration for treating PTSD. During an intravenous (IV) infusion, ketamine is delivered directly into the bloodstream over a period of 40-60 minutes, typically at a dose of 0.5 mg/kg body weight. This method provides precise control over dosing and allows for real-time monitoring of the patient’s response and vital signs. IV ketamine has the most robust research evidence supporting its efficacy for treatment-resistant depression and shows promising results for severe PTSD symptoms.
The infusion process requires a clinical setting with trained medical professionals and appropriate monitoring equipment, as patients may experience dissociative effects during treatment. Most patients receive a series of six to eight initial infusions over two to four weeks, followed by maintenance treatments as needed. The IV route offers the advantage of predictable pharmacokinetics, making it easier to achieve therapeutic blood levels consistently. While repeated ketamine infusions require more resources and clinical oversight than other administration routes, it remains the preferred choice for many treatment centers due to its established safety profile and demonstrated effectiveness in clinical studies.
Intramuscular Ketamine
Intramuscular (IM) ketamine administration involves injecting the medication directly into muscle tissue, typically the deltoid (upper arm) or gluteal (buttocks) muscles. This method offers a middle ground between the precision of IV infusion and the convenience of oral or nasal administration. IM ketamine typically reaches peak plasma concentrations within 15-30 minutes and still provides meaningful therapeutic effects, making it suitable for patients who may not tolerate IV procedures or for settings where IV access is challenging.
The intramuscular route has been used extensively in emergency medicine and anesthesia, providing a well-established safety profile. When treating PTSD, IM ketamine yields several advantages including rapid onset of action and relatively high bioavailability. This method may be particularly beneficial for patients with concerns regarding IV access or those who require a more flexible treatment setting. However, IM administration can cause local discomfort at the injection site and may result in less predictable absorption compared to IV infusion, requiring careful monitoring and dose adjustments based on individual patient response.
Intranasal Ketamine (Spravato)
Spravato (esketamine nasal spray) represents the first FDA-approved ketamine-based medication specifically indicated for treatment-resistant depression and, more recently, for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. It has also been prescribed for individuals who have been diagnosed with treatment-resistant anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and other mental health conditions. Esketamine allows for non-invasive administration and can be used in outpatient settings with appropriate monitoring protocols.
The nasal spray formulation provides several practical advantages, including ease of administration, reduced need for IV access, and the ability to treat patients in less intensive clinical settings. Patients self-administer the spray under clinical supervision, with typical dosing occurring twice weekly initially, then moving to weekly or bi-weekly maintenance dosing. While Spravato has lower bioavailability than IV ketamine, it still provides significant therapeutic benefits. The treatment requires a REMS (Risk Evaluation and Mitigation Strategy) program due to potential side effects, and patients must be monitored for at least two hours after each dose. This method offers an accessible option for patients who might not otherwise have access to ketamine treatment while maintaining important safety protocols.
Sublingual Ketamine
Sublingual ketamine administration involves placing specially formulated tablets or liquid solutions under the tongue, where the medication is absorbed directly through the mucous membranes into the bloodstream. This route results in higher bioavailability than oral administration while offering greater convenience than IV infusion. Sublingual ketamine typically reaches peak plasma concentrations within 30-60 minutes and provides therapeutic effects lasting two to four hours.
The sublingual route offers several compelling advantages when treating PTSD patients, including the ability to administer treatment in home or office settings with appropriate safety protocols, reduced healthcare system burden, and improved patient autonomy. Bioavailability, while lower than IV administration, still provides clinically meaningful therapeutic effects. This method may be particularly suitable for maintenance therapy or for patients who have responded well to initial IV treatments and wish to transition to a more convenient option. However, sublingual ketamine requires careful patient selection, thorough safety education, and established protocols for monitoring and emergency response, as patients may experience dissociative effects in unsupervised settings.
How Ketamine Differs from Traditional PTSD Treatments
Ketamine’s mechanism of action fundamentally differs from traditional PTSD treatments, offering a novel approach to addressing treatment-resistant symptoms. While conventional medications like SSRIs and SNRIs work by modulating neurotransmitter levels over weeks to months, ketamine acts as an NMDA receptor antagonist, producing rapid changes in neural plasticity and glutamate signaling. This unique mechanism allows ketamine to potentially “reset” maladaptive neural circuits associated with traumatic memories, often producing noticeable improvements within hours to days rather than the weeks typically required for traditional antidepressants to take effect.
Traditional PTSD treatments primarily focus on psychotherapy approaches like Cognitive Processing Therapy, Prolonged Exposure, and EMDR, combined with medications that address specific symptom clusters. While these evidence-based treatments are effective for many patients, some individuals with PTSD continue to experience significant symptoms despite adequate trials of first-line treatments. Ketamine therapy can serve as a valuable adjunct to these traditional approaches, potentially enhancing the effectiveness of psychotherapy by reducing symptom severity and improving emotional regulation. The rapid onset of ketamine’s effects may provide a critical window of opportunity for patients to engage more effectively with trauma-focused therapies, creating a synergistic treatment approach that addresses both the neurobiological and psychological aspects of PTSD recovery.
Contraindications and Precautions for Ketamine Therapy
Ketamine therapy requires careful screening to identify patients who may not be suitable candidates due to medical or psychiatric contraindications. Exclusion criteria include uncontrolled hypertension, severe cardiovascular disease, history of psychotic disorders such as schizophrenia or bipolar disorder with psychotic features, and active substance use disorders involving ketamine or other dissociative drugs. Patients with a history of intracranial pressure elevation, severe liver disease, or hyperthyroidism also require careful evaluation and may not be appropriate candidates for ketamine treatment.
Relative contraindications and precautions include pregnancy and breastfeeding, history of substance abuse, unstable medical conditions, and concurrent use of medications that may interact with ketamine. Patients with a history of dissociative disorders or those who have experienced adverse reactions to anesthetics should be evaluated on a case-by-case basis. Additionally, individuals with poorly controlled psychiatric conditions, active suicidal ideation without proper safety measures, or those unable to provide informed consent may require stabilization before considering ketamine therapy. Thorough medical and psychiatric screening, including cardiovascular assessment and substance use evaluation, is essential to ensure patient safety and optimize treatment outcomes.
Side Effects and Risk Management
Ketamine therapy can produce both acute and potential long-term side effects that require careful monitoring and management protocols. Common acute side effects include dissociation, dizziness, nausea, increased blood pressure and heart rate, blurred vision, and feelings of floating or detachment from reality. These effects typically occur during and immediately after treatment, usually resolving within one to two hours post-infusion. Most patients find these effects manageable and even therapeutic, as the dissociative experience may help process traumatic memories from a detached perspective.
More serious but less common side effects include significant hypertension, emergence reactions (agitation, confusion, or hallucinations), and in rare cases, respiratory depression. Long-term risks associated with chronic ketamine use include potential bladder toxicity (cystitis), cognitive impairment, and psychological dependence, though these are primarily concerns with illegal recreational use rather than supervised medical treatment. Risk management strategies include comprehensive pre-treatment screening, continuous monitoring during treatment sessions, having emergency protocols in place, and maintaining clear communication with patients about potential side effects. Clinicians should provide patients with detailed post-treatment instructions and 24-hour contact information for any concerns.
Patient Selection Criteria
Appropriate patient selection is crucial for ketamine therapy success and safety in throughout the treatment period. Ideal candidates typically include adults with a diagnostic history of PTSD who have failed to respond adequately to at least two evidence-based treatments, including both psychotherapy and pharmacological interventions. Patients should demonstrate treatment-resistant symptoms that significantly impair daily functioning, relationships, or quality of life despite engaging in traditional therapies for an adequate duration and intensity. Additionally, candidates should be medically stable, psychologically prepared for the dissociative experience, and able to provide written informed consent prior to starting ketamine.
Assessment criteria should include a comprehensive psychiatric evaluation, medical clearance including cardiovascular screening, substance use assessment, and evaluation of social support systems. Inclusion criteria includes the ability to attend regular treatment sessions and comply with safety protocols, including post-treatment monitoring and transportation arrangements. Those with stable housing, reliable support systems, and realistic expectations about treatment outcomes tend to have better therapeutic responses. Exclusion criteria include active psychosis, severe personality disorders that may interfere with treatment compliance, current substance abuse, unstable medical conditions, and inability to understand or consent to treatment. A collaborative approach involving the patient, family members when appropriate, and the treatment team helps ensure optimal patient selection and treatment planning.
Monitoring Requirements During Treatment
Ketamine therapy requires comprehensive monitoring protocols to ensure patient safety and optimize therapeutic outcomes. Pre-treatment monitoring includes baseline vital signs, psychological assessment, and review of current medications and medical conditions. During treatment sessions, continuous monitoring should include blood pressure, heart rate, oxygen saturation, and neurological status, with particular attention to signs of hypertension, respiratory depression, or severe dissociative reactions. Most treatment protocols require monitoring every 15-30 minutes during the infusion and for at least two hours post-treatment until the patient returns to baseline functioning.
Post-treatment monitoring involves assessing recovery from dissociative effects, ensuring stable vital signs, and confirming that patients can safely ambulate and communicate clearly before discharge. Patients should not drive or operate machinery for at least 24 hours after treatment and should have a responsible adult available for transportation and supervision. Long-term monitoring includes regular psychiatric assessments to evaluate treatment response, side effect monitoring, and adjustment of treatment protocols as needed. Documentation should include detailed treatment notes, adverse event reporting, and regular outcome assessments using standardized PTSD rating scales. Emergency protocols should be clearly established, with staff trained in ketamine reversal procedures and immediate access to emergency medical services when needed.
What to Expect During Your First Ketamine Session
Your first ketamine treatment session will begin with a comprehensive pre-treatment evaluation, including vital sign assessment, review of medical history, and discussion of treatment goals and expectations. The clinical team will explain the process step-by-step, address any concerns, and ensure you feel comfortable and prepared for the experience. You’ll be asked to fast for several hours before treatment to reduce the risk of nausea, and comfortable clothing is recommended as you’ll be resting in a treatment chair or bed during the session.
During the actual treatment, you’ll be in a quiet, controlled environment with dimmed lighting and the option for calming music or guided meditation. The ketamine will be administered according to your prescribed method, with medical staff continuously monitoring your vital signs and comfort level. You may begin to experience dissociative effects within minutes, which can include feelings of floating, detachment from your body, or altered perception of time and space. These effects are normal and typically described as dreamlike or meditative. The treatment team will check on you regularly, and you can communicate any concerns or discomfort at any time. After the treatment, you’ll remain in the clinic for observation until the effects subside and you feel ready to leave with your designated driver.
Treatment Protocols and Dosing Schedules
Ketamine treatment protocols for PTSD typically follow established guidelines while allowing for individualization based on patient response and tolerance. Most treatment centers use an induction phase consisting of six to eight treatments over two to four weeks, followed by maintenance treatments as needed. For IV ketamine, doses typically range from 0.5-1.0 mg/kg administered over 40-60 minutes, with some protocols using lower-dose ketamine initially and titrating upward based on response and tolerability. Treatment frequency during the induction phase is usually two to three times per week, allowing for optimal therapeutic effects while minimizing side effects.
Maintenance treatment schedules vary significantly based on individual response patterns, with some patients requiring weekly treatments while others may maintain benefits with monthly or even less frequent sessions. For Spravato (esketamine nasal spray), the FDA-approved protocol includes twice-weekly treatments for the first month, followed by weekly treatments for the second month, then weekly or bi-weekly maintenance dosing. Dosing schedules should be individualized based on symptom severity, treatment response, side effect profile, and patient preferences. Regular assessment using clinician-administered PTSD scales helps guide treatment frequency adjustments and ensures optimal therapeutic outcomes while minimizing treatment burden and costs.
Duration of Treatment and Maintenance Therapy
The duration of ketamine therapy for PTSD varies significantly among individuals. Some patients experience a significant difference in their symptoms after a single ketamine infusion or after a short course of treatment, while others require ongoing maintenance therapy. Most patients begin to notice improvements within the first few treatments, with optimal benefits typically achieved after completing the initial induction series of six to eight sessions. The acute antidepressant properties and anti-anxiety effects of ketamine can last from several days to several weeks, depending on individual factors such as metabolism, severity of symptoms, and concurrent treatments.
Maintenance therapy protocols are highly individualized and may range from weekly to monthly treatments, with some patients maintaining benefits for months between sessions. Factors influencing maintenance requirements include initial treatment response, symptom severity, concurrent psychotherapy engagement, stress levels, and individual neurobiological factors. Long-term treatment planning should involve regular reassessment of symptoms, functional improvement, and quality of life measures. Some patients may eventually discontinue ketamine therapy while maintaining benefits through continued psychotherapy and lifestyle modifications, while others may require ongoing treatment to sustain optimal functioning. The goal is to find the minimum effective treatment frequency that maintains therapeutic benefits while minimizing costs and treatment burden.
Combining Ketamine with Psychotherapy
The integration of ketamine therapy with psychotherapy represents a promising approach that may enhance treatment outcomes for PTSD patients. Ketamine’s rapid reduction of symptoms and enhancement of neuroplasticity can create an optimal window for therapeutic engagement, potentially making patients more receptive to trauma-focused interventions. Many clinicians recommend scheduling psychotherapy sessions within 24-48 hours of ketamine treatment when patients may be experiencing reduced hypervigilance, decreased emotional numbing, and increased cognitive flexibility.
Trauma-focused therapies such as EMDR, Cognitive Behavioral Therapy, and Prolonged Exposure Therapy may be particularly effective when combined with ketamine, as the medication can reduce the intensity of trauma-related distress and facilitate processing of difficult memories. Some treatment centers offer ketamine-assisted psychotherapy, where therapeutic sessions occur during or immediately after ketamine administration, allowing patients to explore traumatic memories in a dissociated state. However, this approach requires specialized training and careful consideration of timing, dosing, and therapeutic techniques. The combination approach should be carefully coordinated between prescribing physicians and psychotherapists, with clear communication about treatment goals, timing, and patient progress to optimize the synergistic benefits of both interventions.
Research Evidence for Ketamine in PTSD
The research evidence for using ketamine to treat post-traumatic stress disorder (PTSD) is expanding, with multiple studies demonstrating promising results for this treatment-resistant population. Early controlled trials have shown significant reductions in symptoms in PTSD patients who had not responded to traditional treatments. A study published in the American Journal of Psychiatry (Feder et. al, 2021) found that a single ketamine infusion produced rapid and sustained improvements in PTSD symptoms, with benefits lasting up to nearly four weeks post-treatment. Subsequent studies have confirmed these findings and explored optimal dosing protocols and treatment frequencies.
Recent systematic reviews and meta-analyses have concluded that ketamine demonstrates significant efficacy for PTSD symptoms, particularly in treatment-resistant cases. The research suggests that ketamine not only reduces core PTSD symptoms but also improves associated conditions such as depression, anxiety, and suicidal ideation. Neuroimaging studies have provided insights into ketamine’s neural mechanisms of action, showing increased connectivity in brain regions associated with emotional regulation and decreased hyperactivity in trauma-related neural circuits. While more large-scale, long-term studies are needed to fully establish ketamine’s place in chronic PTSD treatment, the current evidence supports its use as a safe and effective option for patients who have not responded to conventional therapies.
Success Rates and Treatment Outcomes
Success rates for ketamine therapy in treating post-traumatic stress disorder (PTSD) vary depending on study design, patient population, and outcome measures, but consistently show encouraging results. Clinical trials report response rates ranging from 50-80% for treatment-resistant PTSD patients (e.g. – Jumaili et al., 2022). Remission rates, indicating minimal residual symptoms, range up to 80% (Fremont et al., 2023), depending on the study and follow-up period. These outcomes are particularly impressive given that most study participants had failed multiple previous treatments.
Real-world clinical data supports these research findings, with many treatment centers reporting similar success rates in their patient populations. Outcomes tend to improve with repeated treatments, with many patients experiencing progressively better symptom control throughout the induction series. Quality of life measures show significant improvements, including better sleep, improved relationships, increased work productivity, and enhanced overall functioning. Factors associated with better outcomes include younger age, shorter duration of illness, concurrent psychotherapy engagement, and strong social support systems. While individual responses vary, the majority of patients experience at least some benefit from ketamine therapy, with many describing it as life-changing or the first treatment that provided meaningful relief from their PTSD symptoms.
How Do I Pay For My Ketamine Therapy?
Balanced Mind of New York is a private pay practice and does not accept insurance. We believe in providing individualized, high-quality care without the restrictions or limitations often associated with insurance-based treatment.
If you have out-of-network benefits, we’re happy to provide a superbill upon request, which you can submit directly to your insurance provider for potential reimbursement. Please consult your provider to understand your coverage and eligibility for out-of-network mental health services.
Contact Details for Balanced Mind of New York Ketamine Therapists
Please contact us at [email protected] or 646-883-5544 to schedule an appointment and take the first step toward a healthier you.