IV Ketamine Superior to IV Midazolam in Adults with PTSD
In a recent study, ketamine performed better than an active comparator on several measures in adults with post-traumatic stress disorder (PTSD). Since ketamine has noticeable dissociative effects, researchers have looked for another drug with mind-altering effects that would be a more appropriate comparator than placebo.
At the 2013 meeting of the American Academy of Child and Adolescent Psychiatry, Adriana Feder of Mount Sinai Hospital reported on the randomized study in those with PTSD, in which intravenous ketamine was compared to intravenous midazolam, a potent benzodiazepine that produces anti-anxiety and sedating effects. Murrough et al. previously showed that intravenous ketamine was superior to midazolam in treatment-resistant depression.
In the randomized study Feder described, the participants had suffered PTSD from a physical or sexual assault and had been ill for 12 to 14 years. Those who received ketamine improved more, in some instances for as long as two weeks (ketamine’s blood levels disappear after a few hours, and its clinical antidepressant effects usually last only a few days). Reports of side effects included three patients with blood pressure increases requiring treatment with propranolol, and four patients who each had a transient episode of vomiting.
These controlled data parallel previous open observations. When ketamine was used as a surgical anesthetic during operations on burn patients, only 26.9% subsequently reported PTSD compared to 46.4% who developed PTSD when an alternative to ketamine was used as the anesthetic.
