KETAMINE science & education

Ketamine Educational Videos

A short 4 minute summary on the work done by Yale professiors in the Depression Research Program

An entertaining TED talk by neuroscientist Rebecca Brachman, PhD, a pioneer in the field of preventative psychopharmacology, where the history of antidepressants is explored and how we stumpled upon ketamine 

Ronald S. Duman, PhD, professor of neurobiology and pharmacology at Yale School of Medicine, discusses the advances in the treatment of depression (April 2011)- 24min

NPR short with Dr. Duman talking about the benefits and mechanism of depression and the benefits of ketamine therapy. – 4min

Ketamine- Scientific Studies

JAMA Psychiatry – A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders
JAMA Psychiatry. 2017;74(4):399-405. doi:10.1001/jamapsychiatry.2017.0080

Nature – Ketamine Steps out of the darkness –  doi:10.1038/nature17897
This article dives deeper into the anti depressive mechanisms of ketamine and it’s metabolism. Note the importance of R-ketamine. 

NIH – Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial.   doi:10.1176/appi.ajp.2013.13030392
Double blind study demonstrating the antidepressive effects of a single dose IV ketamine infusion following 24 hours and 1 week. Note that an intial treatment series of 6 over 3-4 weeks is recommended

Biol Psychiatry Cognb Neurosci Neuroimaging – Effects of serial ketamine infusions on cortico-limbic funcitonal connectivity in major depression. doi:10.1016/j.bpsc.2020.06.015
This neuroimaging (functional MRI) study goes into great detail on the different brain regions affected by single and serial ketamine infusions. New connections are formed that result in restoration of top-down control of emotional processing and brain regions associated with major depressive disorder and anxiety. The authors note this is an open-label study because “previous randomized placebo-controlled trials have clearly established the superiority of ketamine over placebo in improving depression and…because of the ethical implications of including a placebo group in TRD volunteers.”

Sage Journal – Systematic review and meta-analysis of randomized controlled trials of ketamine in the treatment of refractory anxiety spectrum disorders.  doi: 10.1177/2045125321105674
First systemic review of its kind looking at acute ketamine studies in the use for anxiety spectrum disorders. The preliminary results demonstrates ketamine may be broadly effective accross treatment resistant anxiety spectrum disorders. 

Neuropsychopharmacology – Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial doi: 10.1038/npp.2017.194
This double blind, randomized, placebo-controlled crossover trial is meant to demonstrate proof-of-concept for potenital use of ketmaine for anxiety reduction.

Neuropsychopharmacology. Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder: Proof-of-Concept 
This randomized controlled trial demonstrated that ketamine showed a rapid reduction in obsessions during the infusion those effects persisted 1 week post infusion compared to placebo. In addition, crossover effects suggest ketmaine’s effect on OCD symptoms last longer than previously reported.

Harvard Review of Psychiatry: Ketamine in the Treatment of Obsessive-Compulsive Disorder: A Systemic Review
This review analyzes nine different studies looking at the effects of ketamine in OCD. They do note the need for future randomized, double-blind, placebo-controlled trials in order to further detrmine the mechanism and optimal dosing and psychiatric interventions are most effective. It is important to remember that most of the data exists for depression and that some patients with OCD had phenominal results where as others did not.

DIC: Ketamine as treatment for post-traumatic stress disorder: a review 2019 doi: 10.7573/dic.212305 This review article looks at the current data in the treatment of PTSD as well as mechanism of action of the drug. In summary the data demonstrates near complete resolution of symptoms over the short term and the findings overal are similar to major depressive disorder (MDD).

Am J Psychiatry. A Randomized Controlled Trial of Repeated Ketamine administration for chronic post traumatic stress disorder. 2021 doi:10.1176/appi.ajp.2020.20050596 
Double-blind single-arm study demonstrating the benefits or repeated ketamine infusions for the treatment of chronic PTSD
Chronic Regional Pain Syndrome (CRPS)/Phantom Limb Pain (PLP)

The RSD Foundation website is an excellent resource for anyone suffering from CRPS who would like more information on the disease. The page goes into great detail on the benefits of ketamine and they graciously share their protocols for providers.

Clin J Pain. Optimizing the Treatment of CRPS With Ketamine. 2020 doi: 10.1097/AJP.0000000000000831
This study details the protocol for treatment of CRPS with ketamine and demonstrates its effectiveness. In this study 4 day 4 hour infusions of ketamine are shown to be sufficient for lower extremity procedures and more sessions may be needed for upper extremity.

Healhth Psychol Res. Ketamine for the Treatment of Chronic Pain: A Comprehensive Review 2021. doi: 10.52965/001c.25535
This review explores the role of Ketamine as an alternative treatment option for conditions such as neuropathic pain, fibromyalgia, CRPS, and phantom limb pain (PLP), cancer pain, and post-thoracotomy pain syndrome (PTPS). This review concludes the evidence for it’s use in fibromyalgia, cancer and PTPS is lacking however if pain has a neuropathic component (CRPS, PLP, neuropathic pain ) then seems ketamine can be of great benefit demonstatting improved pain symptoms, patient satisfaction, and qualtiy of life. 

Reg Anesth Pain Med. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists 2018. doi:10.1097/AAP.0000000000000808
The joint effort of the American Society of Regional Anesthesia (ASRA) and the American Academy of Pain Medicine (AAPM) developed a consensus on the use of IV ketamine, it’s side effects, and monitorying standards based on the available data to date. There is evidence to support it’s use in CRPS.

Cochrane Reviews. Pharmacologic Interventions for Treatment Phantom Limb Pain. 2016. doi: 10.1002/14651858.CD006380.pub3
Overall ketamine demonstrates a favorable analgesic efficacy int he treatment of PLP however these were small studies and more long term studies are needed.

PubMed – Treatment of Complex Regional Pain Syndrome

PubMed – Double-Blind Placebo Controlled Study

 2018; 9: 277 – Efficacy of ketamine in the Teratment of Substance Use Disorders: A Systemic Review. doi: 10.3389/fpsyt.2018.00277 
This review identified seven completed studies that identified benefits of ketamine in the treatment of alcohol, cocaine, cannabis and opioid use disorders. Benefits include improvement in cravings, motivation, as well as abstinence rates.