By Cory Fowler
In a recent study released in the American Journal of Psychiatry, scientists from the Icahn School of Medicine at Mount Sinai concluded that recurrent intravenous (IV) ketamine infusions dramatically lessen symptoms of chronic post-traumatic stress disorder (PTSD). The effects were both rapid and lasted for multiple weeks. Adriana Feder, MD, Associate Professor of Psychiatry at the Icahn School of Medicine expressed her optimism about this potential new treatment, citing “Our findings provide insight into the treatment efficacy of repeated ketamine administration for PTSD…as a large number of individuals are not sufficiently helped by currently available treatments.”
Mount Sinai researchers conducted their first proof-of-concept trial with a single dose IV ketamine which exhibited impressive results 24 hours after use. Already approved by the U.S. Food and Drug Administration as an anesthetic agent back in 1970, it functions with N-methyl-d-aspartate (NMDA) receptors in the brain while most antidepressants focus on serotonin, norepinephrine, and dopamine- often taking several weeks to months before any effect is noticed; not even helping one-third of those who take them.
As Dennis S. Charney, MD said “The data presented in our current study …indicating that in addition to being rapid, ketamine’s effect can be maintained over several weeks” providing hope that those suffering from PTSD will find relief much sooner than previously expected.
For the current investigation, participants were selected at random to receive six infusions of ketamine given three times weekly during a two-week period, in contrast to a placebo control of midazolam (chosen due to it possessing similar pharmacokinetic parameters and nonspecific behavioral effects to ketamine). Study members had extreme chronic PTSD stemming from civilian or military trauma, with the average length being 14 years and almost half taking additional psychiatric medications. The major traumas recorded by individuals included sexual molestation/assault, physical injury/abuse, violent death sightseeing, enduring 9/11 happenings, and combat confrontation.
All individuals engaged in the study had their baseline ratings ascertained as well as assessments conducted each week at weeks 1 & 2 plus on every ketamine infusion day by teams of practiced study raters who utilized the Clinician-Administered PTSD Scale for DSM-5 & the Montgomery-Asberg Depression Rating Scale (MADRS) – usual rating scales used for gauging both depression & PTSD.
Statistically more people in the ketamine group (67 percent) achieved a minimum 30 percent decline in signs from initial evaluation during week 2 than those in midazolam team (20 percent). Moreover, ketamine doses led to distinct improvements through 3 out of the 4 PTSD indication collections – interference, evasion as well as negative thoughts/mood shift. Those under the ketamine category showing effects experienced quick enhancement 24 hours subsequent to a first shot which was sustained for median of 27.5 days past the primary outcome assessment date. Additionally to advancement in PTSD signals, members of the ketamine cohort showed a notably greater discount in concomitant depressive indications compared to those in the midazolam group – this is significant considering the high level of co-occurrence existing between depression & PTSD. Results also suggested that repeated applications of ketamine are safe plus usually tolerated among persons having persistent PTSD.
Dr. Feder added that “We need further studies containing multiple dosages over time & evaluating how combining multiple ketamine infusions with trauma-focused psychiatric therapy might perpetuate this substantial reaction over a longer duration so that affected people have access to much-required relief.”
Drs. Charney and Feder have been designated as co-inventors on an issued patent in the USA, with some further patents outside the country which were submitted by the Icahn School of Medicine at Mount Sinai, for exploiting ketamine as a treatment for PTSD.
This project was financially supported by a grant from NARSAD Independent Investigator Award of Brain & Behavior Research Foundation (PI Dr. Feder), magnanimously given by Mr. Gerald Greenwald and Mrs. Glenda Greenwald, in addition to subsidies from Mount Sinai Innovation Partners via the i3 Accelerator, an investment worth $10 million that permits recent advances at Mount Sinai to be quickly implemented so they can be used to benefit patients more rapidly. Furthermore, the Ehrenkranz Laboratory for Human Resilience of the Facility for Discovery and Treatment of Depression and Anxiety at ISMMS also provided money for this research.
