Ketamine and PTSD: How Ketamine Is Helping to Rewire Trauma Survivors

Post traumatic Stress Disorder (PTSD) is a complex condition that affects many Canadians. While traditional treatments for PTSD, such as Selective Serotonin Reuptake Inhibitors (SSRIs) and prolonged exposure therapy, can be effective, they have limitations. But ketamine? It’s a bit different, but is showing promise as a powerful tool in the toolkit for PTSD patients. When administered through repeated ketamine infusions and combined with psychotherapy, evidence is mounting that this treatment may be an important treatment option.

In this article, we’ll explore ketamine and PTSD, how it works, and why it’s transforming the lives of so many of my patients. We’ll look at everything from the science behind ketamine to the practical steps of getting treatment here in Canada.

Understanding Posttraumatic Stress Disorder and Its Impact on Canadians

Let’s talk about posttraumatic stress disorder (PTSD) for a moment. It’s a term we hear often, but what does it really mean? Post-Traumatic Stress Disorder is like an unwelcome guest that overstays its welcome in your mind. It’s a mental health condition that can develop after experiencing a traumatic stressor, witnessing a traumatic event, or being exposed to real-life traumatic events.

Think of your brain as a filing cabinet. Normally, it processes experiences and files them away neatly. But with post-traumatic stress disorder, it’s as if someone’s knocked the cabinet over, scattering traumatic memories everywhere. These scattered traumatic memories can pop up unexpectedly, causing distress, anxiety disorders, and disrupting daily life.

You might be surprised to learn just how common PTSD is in Canada. It’s not just something that affects military veterans or first responders. In fact, according to a 2008 study, about 9% of Canadians will experience post-traumatic stress disorder in their lifetime. Rates may be higher in certain groups and populations. The condition is certainly more prevalent than some may think. 

I’ve seen PTSD affect all kinds of people. From the postal worker who survived a dog attack to the outgoing chef who witnessed a sexual assault. Post-traumatic stress disorder doesn’t discriminate. It can touch anyone’s life, regardless of age, gender, or background, leading to antidepressant-resistant symptoms and a need for trauma interventions.

Common PTSD Symptoms and Challenges

Living with chronic posttraumatic stress disorder can feel like you’re constantly walking on eggshells. PTSD symptoms can vary, but there are common threads.

In addition to the experiencing of a traumatic experience, flashbacks or re-experiencing are one of the hallmarks of PTSD. Imagine suddenly being transported back to the original traumatic memory or event, complete with sights, sounds, and smells. It can be incredibly disorienting and frightening, as the brain regions associated with memory retrieval are activated. Some patients describe it as feeling like they’re reliving the traumatic event, watching a movie of their worst memory, but they’re in it. Some may experience flashbacks as terrifying nightmares that wake them from sleep and keep them from getting restful sleep. 

Then there’s hypervigilance – always being on high alert. It feels like your brain’s alarm system is stuck in the ‘ON’ position. This can lead to difficulty sleeping, irritability, anxiety, and trouble concentrating. One patient with treatment-resistant PTSD told me it felt like she was “always waiting for the other shoe to drop.”

Avoidance is another common challenge. People with chronic PTSD often go to great lengths to avoid anything that reminds them of their trauma, in an attempt to prevent memory reconsolidation of the traumatic event. This might mean skipping social events, changing jobs, or even moving to a new city.

Mood alterations are another hallmark of PTSD. Patients may feel detachment from self and those around them. They may feel loss of positive emotions, loss of interest, and persistent negative thoughts about themselves and those around them.  

PTSD symptoms can make everyday life feel like climbing a mountain, especially for those with comorbid conditions like major depressive disorder or borderline personality disorder. Simple tasks like going to the grocery store or attending a family gathering can become monumental challenges. It’s important to remember that these reactions are your brain’s way of trying to protect you from traumatic memories and stress, even if they’re not helpful in the long run.

But here’s the good news. PTSD is treatable, and there are several promising pharmacological agents available. While traditional PTSD therapies like prolonged exposure therapy can be effective, they don’t work for everyone. And that’s when ketamine can be helpful for some patients.

The Evolution of Ketamine as a Posttraumatic Stress Disorder Treatment

When I was in medical school, ketamine was primarily known as an anesthetic. Fast forward to today, and it’s changing how doctors approach mental health treatment, especially for depression and chronic posttraumatic stress disorder.

The journey of ketamine from operating rooms to mental health clinics is interesting. Researchers at Yale began noticing its rapid antidepressant effects in the early 2000s, and it wasn’t long before it became a potential novel future intervention for treatment resistant depression. Evidence began to mount over the years for those with treatment-resistant depression. Veterans Affairs in the United States covers ketamine treatments for veterans (Canada is a bit behind but Veterans Affairs Canada will cover ketamine treatments for depression specifically), and recent data from Veterans Affairs Hospital system showed that even in complex patients a significant percentage of patients experienced relief 

I remember when I first heard about ketamine for PTSD. Given the majority of research was on low dose ketamine for depression, I was a bit skeptical. But as I dug deeper into the research, including randomized clinical trials, neuroimaging studies of patients with PTSD, ketamine assisted psychotherapy approaches and systematic reviews of ketamine, I began to understand that that ketamine may be part of a treatment approach for patients with PTSD. After seeing patients who have struggled for years and decades find dramatic symptom reduction from ketamine treatments, leading functional lives after suffering significantly, it was one of the most rewarding things I ever experienced as a physician. It’s been incredible to witness this evolution and be part of it.

How Ketamine Works for PTSD Symptoms

Now, let’s talk about how ketamine actually works and how it can rapidly reduce symptoms of chronic PTSD. 

On a more scientific level, ketamine interacts with something called the NMDA receptor. This interaction triggers a cascade of effects that can rapidly reduce symptoms of PTSD symptoms, as measured by tools like the clinician-administered PTSD scale.

Ketamine’s mechanism of action in treating PTSD involves complex neurobiological processes. To put it simply, ketamine works by influencing a brain chemical called glutamate. Glutamate is like a messenger in the brain, helping with important functions such as learning, forming memories, and allowing the brain to adapt to new situations.

Ketamine interacts with specific receptors called NMDA receptors, which are like switches that glutamate normally activates. The downstream effect of this interaction is increases in neurogenesis and neuroplasticity, which may be impaired by the chronic stress of PTSD. There is a reduction in the default mode network, an idle brain network that is often thought of as the resting place of maladaptive thoughts. Some liken ketamine’s effect to a “reboot”  of the brain’s stress response system, which is often out of balance in individuals with PTSD. These processes can result in the rapid improvements studies show for patients in symptoms such as anxiety, depression, and intrusive thoughts that are common in PTSD.

Traditional exposure based therapy for PTSD relies on the brain’s process of extinction learning and memory reconsolidation. In simple terms, over time we can change the traumatic memory and the linking of the trauma response to that memory. In patients with PTSD, the process of reconsolidating that memory may be impaired. Ketamine’s ability to induce neurogenesis and neuroplasticity through the NMDA receptor is thought to be the reason why it improves the reconsolidation process. Neuroimaging studies show that ketamine reduces the connection between the amygdala, the fear and anxiety centre of the brain, and the hippocampus, the memory centre of the brain.  Coupled with psychotherapy, ketamine may help this natural process of relearning a new response to a traumatic memory. It’s as if ketamine gives your brain a fresh canvas and some new paint, allowing you to create healthier thought patterns and process your traumatic events and traumatic memories differently.

Ketamine’s Safety Profile for PTSD Patients

“Isn’t ketamine a party drug? Is it really safe?” It’s a valid concern, and one we hear often. The truth is, when used in a controlled medical setting at a dose of 0.5 mg/kg, one quarter of the anesthetic dosing or less, ketamine has a remarkably good safety profile. When administered in controlled, sub-anesthetic doses, ketamine has minimal impact on respiratory and cardiovascular functions.

A review piece including recent randomized clinical trials noted that low-dose ketamine had no adverse events in PTSD trials. 

The doses of ketamine (0.5 mg/ kg) we use for PTSD treatment are much lower than those used for anesthesia or illicitly in recreational settings.

During treatment, we closely monitor vital signs and have protocols in place to ensure patient safety. Most side effects, if they occur, are mild and short-lived. Some patients experience a temporary increase in blood pressure or feelings of dissociation during the ketamine infusion, but these typically resolve quickly.

That being said, ketamine isn’t for everyone. We always conduct thorough evaluations, including a structured clinical interview, before starting treatment. It’s crucial to have a complete picture of a patient’s health history, including any history of bipolar disorder or schizoaffective disorder, and current medications to ensure ketamine is a safe option for them. We also carefully consider exclusion and inclusion criteria to ensure the best possible outcomes.

Most PTSD patients tolerate repeated ketamine treatments for treatment-resistant depression. Some describe the experience as profound and peaceful, despite initial apprehensions.

Remember, while ketamine can be a powerful tool in treating chronic PTSD, it’s not a magic bullet. It works best as part of a comprehensive treatment plan, often including trauma-focused psychotherapy and lifestyle changes.

Ketamine Administration Routes for Posttraumatic Stress Disorder Treatment

Ketamine treatment for chronic PTSD is not a one-size-fits-all approach. There are actually several ways of ketamine administration, and each has its own unique benefits.

The most common method is intravenous ketamine (IV) infusion, typically at a dose of 0.5 mg/kg. In this randomized controlled trial, findings suggest that even a single ketamine infusion can make a significant difference in PTSD symptoms, as measured by the clinician-administered PTSD scale. Doctors carefully control the dose and rate of repeated ketamine infusions, tailoring it to each patient’s needs based on their treatment response. Some PTSD patients joke that it’s like getting a “brain spa day.”

There’s also intramuscular (IM) injection, which is quick and easier to administer. It’s a bit like getting a flu shot. Nasal sprays are another option, particularly where regulations are strict around where intramuscular injections can be administered. Sublingual lozenges are another route of administration. These are tablets that dissolve under the tongue. 

Ketamine therapy protocols for Posttraumatic stress disorder treatment

A typical ketamine treatment plan for chronic posttraumatic stress disorder follows the standard of six ketamine sessions over three weeks, often combined with trauma-focused psychotherapy sessions. Each session lasts about 2-2.5 hours, give or take, with the experience of the medicine typically lasting an hour or less. 

After this initial series, some patients may move into a maintenance phase. Generally when patients can process their traumatic experience deeply and more meaningfully, many will find they do not need maintenance treatment. In the depression literature, maintenance has been shown to prevent relapse. The decision for maintenance is a patient specific decision. If patients require maintenance, it might be a booster every few weeks, while others can go months between treatments or not receive. It all depends on their individual needs and treatment response.

Throughout the process, we’re constantly checking in, monitoring vital signs, administering the PTSD checklist, and adjusting doses to ensure that the ketamine treatment is working optimally for each patient with posttraumatic stress disorder.

Ketamine-assisted psychotherapy for Posttraumatic stress disorder treatment

Ketamine on its own can be powerful, but when we combine it with psychotherapy, the benefits can be more profound and more enduring.

Imagine your mind as a snow globe. Chronic PTSD has shaken things up, and everything’s swirling around chaotically. Ketamine can help settle the snow, creating a brief window where the mind is more open and flexible, facilitating memory retrieval and reconsolidation. That’s when we bring in psychotherapy to help rearrange the scenery inside the globe.

We call this Ketamine-Assisted Psychotherapy (KAP). It’s like having a guide with you as you explore the newly cleared pathways in your mind. The psychotherapy can happen during the ketamine infusion or treatment itself, or in the days following when the brain is still in that receptive state.

Patients with PTSD have noted they can make breakthroughs in KAP sessions that might have taken months or years with traditional therapies alone. It’s as if the ketamine provides a shortcut to the subconscious, allowing for deeper, more meaningful work by facilitating the processing of traumatic memories.

One patient described it as “finally being able to look at my sexual assault without feeling overwhelmed by it.” Another said it felt like “rewiring my brain to respond differently to triggers.”

Of course, this doesn’t mean ketamine replaces traditional therapy. Instead, think of it as a powerful tool in our therapeutic toolbox, one that can help accelerate the healing process and enhance the effectiveness of trauma-focused psychotherapy.

Ketamine and psychotherapy together may help make your PTSD treatment journey a little better, a little faster, and ultimately, more successful and longer lasting.

The Effectiveness of Ketamine in Treating PTSD

While traditional PTSD treatments like SSRIs have been real lifesavers for many patients, they don’t always hit the mark for everyone, especially those with treatment-resistant depression, PTSD, or obsessive-compulsive disorder.

That’s where ketamine, particularly a series of repeated ketamine administrations, can truly make a difference. I’ve seen it work wonders for PTSD patients who thought they were out of options, with randomized controlled trials and systematic reviews consistently showing the efficacy of ketamine infusions for rapidly reducing PTSD symptoms.

Ketamine is just one tool in the toolkit, just like SSRIs and exposure based therapies. It is a good thing to have different tools in our mental health toolbox. Sometimes you need a hammer, sometimes you need a screwdriver, right?

I’ve compiled a list of research studies on the effectiveness of ketamine for treating PTSD:

Research Name	Researchers	Short Description	Key Findings
Effectiveness of Ketamine for the Treatment of Post-Traumatic Stress	Almeida et al.	A systematic review and meta-analysis of ten studies, including RCTs and non-randomized trials, assessing the effectiveness of ketamine in treating PTSD.	Significant improvements in PTSD symptoms were noted at the treatment endpoint.
Evidence for the Beneficial Effect of Ketamine in the Treatment of PTSD	Albuquerque et al.	This systematic review and meta-analysis analyzed the effect of ketamine on PTSD symptoms, finding it to be a promising treatment option with rapid antidepressant effects.	Ketamine was found to have rapid antidepressant effects, significantly reducing PTSD symptoms.
Long Term Structural and Functional Neural Changes Following Ketamine Treatment	Duek et al.	This study investigated long-term neural changes in PTSD patients treated with ketamine, showing lower amygdala reactivity and significant neural changes.	Lowered amygdala reactivity and significant long-term neural changes were observed.
A Randomized Controlled Trial of Repeated Ketamine Infusions	Feder et al.	An RCT providing evidence for the efficacy of repeated ketamine infusions in reducing PTSD symptom severity, with significant improvements noted in CAPS-5 and MADRS scores.	Repeated ketamine infusions significantly reduced PTSD symptom severity.
Ketamine for Adults With Treatment-Resistant Depression or PTSD: A 2023 Update	CADTH	A comprehensive review evaluating the clinical effectiveness and cost-effectiveness of ketamine for treating PTSD and TRD, providing updated guidelines and recommendations.	Ketamine was found to be clinically effective and cost-effective for treating PTSD and TRD.
Ketamine Can Rapidly Reduce Symptoms of PTSD and Depression	Annals of Pharmacotherapy	A meta-analysis showing that ketamine can reduce PTSD symptoms by about 25% within one day and one week after therapy, with modest reductions in depression symptoms.	Ketamine reduced PTSD symptoms by about 25% within one day to one week.
Efficacy of Intravenous Ketamine for Treatment of Chronic PTSD	Feder et al.	This proof-of-concept RCT demonstrated that a single intravenous dose of ketamine significantly reduced PTSD symptom severity compared to midazolam, with rapid onset of effects.	A single intravenous dose significantly reduced PTSD symptoms compared to midazolam.

Comparing Ketamine to Traditional PTSD Treatments (SSRIs)

I’ve seen PTSD treatments evolve in fascinating ways. While SSRIs have been a go-to option for many patients, they’re not always the perfect fit. Particularly for those with treatment-resistant PTSD or comorbid conditions like major depressive disorder.

Ketamine can be effective, especially when combined with trauma-focused psychotherapy or mindfulness-based extinction training. Randomized clinical trials published in journals like JAMA Psychiatry and Biological Psychiatry have shown that ketamine can rapidly reduce PTSD symptoms, often within hours of the first infusion.

Feature	SSRIs	Ketamine
Mechanism of action	Increases serotonin levels	NMDA receptor antagonist
Onset of action	4-6 weeks	Within hours
Route of administration	Oral	IV, IM, intranasal, sublingual
Side effects	Sexual dysfunction, weight gain, somnolence, nausea	Dissociation, blood pressure increase (transient)
Efficacy for treatment-resistant PTSD	Limited	Promising, based on clinical trials

Accessing Ketamine Treatment for Posttraumatic Stress Disorder in Canada

Let’s explore how you can actually get ketamine treatment for PTSD here in Canada.

First things first: where do you even start looking for this treatment? It’s not like there’s a “ketamine clinic” on every corner. Then there’s the question of cost – because let’s face it, our wallets matter too. And I’m sure some of you are wondering, “Is this even legal?”

These are all great questions, and ones I hear often in my practice. So let me break it down.

How to find ketamine therapy clinic for posttraumatic stress disorder

So, you’re interested in ketamine therapy for PTSD. Great! But where do you start?

First, you’ll want to find a qualified clinic that offers ketamine administration for PTSD. This isn’t something you want to trust to just anyone. Look for clinics that specialize in ketamine therapy and have experience treating PTSD patients.

It’s a bit like finding a good mechanic. You want someone who knows the ins and outs of your specific model. They will tailor the treatment protocol, whether it’s a single ketamine infusion or repeated ketamine administration, to your needs.

In Canada, we’re seeing more and more clinics offering ketamine therapy. Many are in major cities like Toronto, Vancouver, and Montreal, but the list is growing. Don’t be afraid to do your research and ask questions about inclusion and exclusion criteria, as well as the specific protocols used, such as the ketamine dose (e.g., 0.5 mg/kg) and route of administration (e.g., intravenous ketamine).

A good provider should be happy to explain their approach and qualifications, and may even be involved in clinical trials or research studies published in journals.

Remember, it’s okay to look around a bit. You’re not just looking for someone who can administer ketamine. You’re looking for a partner in your PTSD healing journey.

Does insurance cover ketamine treatment for posttraumatic stress disorder

Ketamine therapy can be pricey, and unfortunately, it’s not typically covered by provincial health plans.

Some private insurance plans may cover part of the cost, especially if it’s prescribed by a psychiatrist as part of a comprehensive treatment plan for PTSD or other mental disorders. However, coverage can vary widely, so it’s important to check with your specific plan.

The cost can vary depending on the clinic and the specific treatment protocol. Generally, you’re looking at anywhere from $300 to $800 per session. But many PTSD patients have found it to be a worthwhile investment in their mental health, especially when compared to the ongoing costs and side effects of traditional pharmacological agents, and the cost of not having mental wellness.

Some clinics offer payment plans. It’s always worth asking about options. Think of it like buying a car. Don’t be afraid to discuss financing.

Is ketamine legal for treating PTSD in Canada?

Patients may ask, is ketamine legal to treat PTSD? The short answer is, yes. 

Ketamine is approved for use as an anesthetic in Canada. Its use for mental health conditions like PTSD is considered “off-label.” This means it’s being used for a purpose other than what it was originally approved for.

Off-label use is completely legal and quite common in medicine. It’s like using a screwdriver to open a paint can. Not what it was designed for, but it works!

Health Canada recognizes the potential of ketamine for mental health and treatment resistant depression. While they haven’t officially approved it for PTSD yet, they allow its use under the care of qualified medical professionals.

It’s important to note that this only applies to ketamine administered in a clinical setting, often intravenously (IV) or through intramuscular injection. Recreational use is still illegal. It’s the difference between taking a prescribed medication under medical supervision and buying illicit psychoactive drugs on the street. One is safe and regulated, the other… not so much.

As research continues to show the benefits of ketamine for PTSD, we may see changes in its official status. For now, rest assured that seeking ketamine treatment for PTSD from a qualified provider is both legal and increasingly accepted in the medical community.

Preparing for Ketamine Treatment for Posttraumatic stress disorder

Alright, let’s talk about getting ready for your ketamine-assisted psychotherapy. You want to make sure you’ve got everything in order before you set off.

In our years of guiding patients through this process at Field Trip Health, I’ve found that a little preparation goes a long way. It’s not just about showing up and getting a single ketamine infusion – there’s a bit more to it than that. We’ve got a few important steps to walk through together.

Step 1: Medical evaluation and screening.

Before you start your PTSD treatment, we need to make sure you’re ship-shape for the voyage.

First, at Field Trip Health, we’ll do a comprehensive medical evaluation. We’ll look at your medical history, current medications, and overall health, including any history of mental disorders like major depressive disorder or obsessive-compulsive disorder. Don’t worry, it’s not as daunting as it sounds. We’re just making sure ketamine administration is safe for you.

We’ll also do some psychological screening using tools like the PTSD checklist. It’s about understanding where you’re starting from so we can plot the best course forward. I’ve written another piece of what disqualifies you from ketamine therapy which you can check out if you have any concerns that you won’t qualify.

Remember, honesty is key here. The more we know, the better we can tailor the treatment protocol, whether it involves a single ketamine infusion or repeated ketamine administration, to your needs.

Step 2: Setting ketamine treatment expectations.

Now, let me share what you can expect from ketamine treatment. It’s not quite like anything you’ve experienced before, and that’s okay.

Some patients describe the ketamine experience as dreamy or surreal. Others say it’s like floating or seeing the world from a new perspective. 

You might experience some physical sensations too. Some people feel light-headed or a bit dizzy. Your vision might get a little blurry. Don’t worry. These effects are temporary and we’ll be monitoring you closely.

It’s important to understand that ketamine isn’t a magic wand. It’s more like a really good paintbrush – a tool that can help you create change, but you’re still the artist. Results can vary, and it might take a few sessions before you notice significant improvements.

Step 3: Psychological preparation.

Preparing your mind for ketamine treatment is just as important as preparing your body.

Patients often set an intention for their treatment. It doesn’t have to be anything grand. It could be as simple as “I want to feel more at peace” or “I hope to better understand my traumatic memories.” This intention can act like a compass, helping guide your PTSD treatment journey. At Field Trip Health, our specialized therapists guide you through your sessions so you can relax and allow the process to take place. 

Our therapists may guide you through some relaxation techniques before your treatment. Deep breathing, meditation, or even just listening to calming music can help put you in the right headspace.

Remember, it’s normal to feel a bit nervous. It can be a normal part of the process of and working towards healing.

Step 4: Practical considerations.

First off, arrange for someone to drive you home after the treatment. The effects of ketamine can linger for a few hours, so you won’t be able to drive. 

On the day of treatment, wear comfortable, loose-fitting clothes. You’ll be lying down for about 1.5 – 2.5 hours, so you want to be cozy. One of my patients always wears her favorite fuzzy socks. Whatever makes you feel relaxed!

Don’t eat for at least 4 hours before the treatment, and avoid clear liquids for 2 hours prior. 

Bring along some music if you like. Many patients find that music enhances their experience and helps with memory reconsolidation. Just make sure it’s something calming. 

Lastly, clear your schedule for the rest of the day after your treatment. You’ll want time to process your experience and rest. Think of it as giving yourself permission to have a mental health day.

Remember, preparing for ketamine treatment is a bit like preparing for a journey of self-discovery. It might seem scary, but with the right preparation and the right guide, it can be an incredibly rewarding experience.

Conclusion

Throughout my years of practice, I’ve witnessed remarkable transformations in patients who’ve undergone ketamine-assisted psychotherapy. It’s not just about alleviating symptoms; it’s about opening doors to new perspectives and possibilities for healing.

For some of our patients it meant processing traumatic memories, overcoming harmful drinking patterns, or finding relief from the debilitating symptoms of chronic PTSD.

Remember, though, that ketamine isn’t a magic bullet. It’s a powerful tool that works best as part of a comprehensive treatment plan. Every individual’s journey with PTSD is unique, and so too should be their approach to treatment.

If you’re considering ketamine therapy for PTSD, reach out to a qualified provider to discuss whether this treatment might be right for you. At Field Trip Health, we specialize in ketamine-assisted psychotherapy and are committed to guiding patients through every step of their PTSD healing journey.

Don’t let Post traumatic stress disorder hold you back any longer. Contact Field Trip Health today to learn more about how ketamine therapy could help you reclaim your life. Our team of experienced professionals is ready to answer your questions and help you explore ketamine treatment options to treat PTSD.

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About the Author

Dr. Mario Nucci MD CCFP is a licensed Family Physician with a passion for mental health and the development of new therapies. He is actively engaged in research with a faculty associate professorship at Northern Ontario School of Medicine, and research collaborations with the University of Ottawa, University of Calgary, Lakehead University, Concordia University and Vancouver Island University.

Dr. Nucci is the founder of Bay and Algoma Health Centre in 2019, a walk-in and addiction medicine clinic. He founded the Canadian Centre for Psychedelic Healing in 2019, now operating as Field Trip Health, providing cutting edge mental health care in Toronto, Montreal, Vancouver, Ottawa, Hamilton,  Kitchener-Waterloo, Thunder Bay, Sault Ste. Marie, and at-home.