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Posttraumatic stress disorder (PTSD) is a debilitating condition affecting up to 8% of the population at some point in their lives. It is a condition that can result from experiencing or witnessing any traumatic (physical or emotional) condition. Up to 20% of individuals who have survived episodes of sexual assault, physical and/or emotional abuse, neglect, accidents, natural disasters, or military combat go on to develop this illness.
PTSD may affect some individuals for the rest of their lives, with or without therapy. The disorder is described as a condition where certain situations trigger the sudden onset of irrational and intrusive thoughts, memories, and fears related to the original stressor, and bring about panic attacks, nightmares, flashbacks, and various phobias, leading to social avoidance, headaches, anxiety, depression, pervasive guilt, and withdrawal from friends and loved ones. PTSD can result in problems at work and with relationships, as well as difficulty with personal advancement and growth, and can increase the risk of drug and alcohol abuse and suicide.
Medical treatment for PTSD traditionally involves SSRI antidepressants, antipsychotics, anxiolytics, and other medications, all with variable success rates, high incidence of untoward side effects, and slow onset of benefit. Psychotherapeutic treatment modalities include cognitive behavioral therapy and eye movement desensitization reprocessing. These therapies have significant role in the treatment of PTSD but can take an extended period to have a lasting effect on the patient’s functioning. They also tend to provide variable and incomplete relief for many patients.
Ketamine infusions are a new tool in the treatment of PTSD. They lead to very rapid improvement in PTSD symptoms, in many cases after the first treatment. The efficacy of ketamine in the treatment of PTSD came about after it was noted in the 1990s that injured soldiers who were treated with ketamine, either as an analgesic or surgical anesthetic, rarely went on to develop PTSD, compared to 30% of soldiers developing PTSD if treated with opiates and other anesthetics during surgery.
It is surmised that ketamine blocks the N-methyl-D-aspartate (NMDA) receptors increasing glutamate in the regions of the brain involved in emotion and long-term memory formation. This causes the suppression of maladaptive emotions and memories, allowing access to more adaptive neural circuitry and leading to more positive emotions and fewer negative memories. However, ketamine infusions are not a cure for PTSD, and should be thought of as an adjunctive therapy that may provide rapid and lasting symptomatic relief from this condition. Patients suffering from PTSD are advised to continue with other therapies with the guidance of a mental health professional.