So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs
ABSTRACTBackground: PTSD is a significant mental health problem worldwide. Current evidence-based interventions suffer various limitations. Ketamine is a novel agent that is hoped to be incrementally better than extant interventions.Objective: Several randomized control trials (RCTs) of ketamine int...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | European Journal of Psychotraumatology |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/20008066.2023.2299124 |
| _version_ | 1797354934297952256 |
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| author | Nicholas C. Borgogna Tyler Owen Jacob Vaughn David A. L. Johnson Stephen L. Aita Benjamin D. Hill |
| author_facet | Nicholas C. Borgogna Tyler Owen Jacob Vaughn David A. L. Johnson Stephen L. Aita Benjamin D. Hill |
| author_sort | Nicholas C. Borgogna |
| collection | DOAJ |
| description | ABSTRACTBackground: PTSD is a significant mental health problem worldwide. Current evidence-based interventions suffer various limitations. Ketamine is a novel agent that is hoped to be incrementally better than extant interventions.Objective: Several randomized control trials (RCTs) of ketamine interventions for PTSD have now been published. We sought to systematically review and meta-analyse results from these trials to evaluate preliminary evidence for ketamine’s incremental benefit above-and-beyond control interventions in PTSD treatment.Results: Omnibus findings from 52 effect sizes extracted across six studies (n = 221) yielded a small advantage for ketamine over control conditions at reducing PTSD symptoms (g = 0.27, 95% CI = 0.03, 0.51). However, bias-correction estimates attenuated this effect (adjusted g = 0.20, 95%, CI = −0.08, 0.48). Bias estimates indicated smaller studies reported larger effect sizes favouring ketamine. The only consistent timepoint assessed across RCTs was 24-hours post-initial infusion. Effects at 24-hours post-initial infusion suggest ketamine has a small relative advantage over controls (g = 0.35, 95% CI = 0.06, 0.64). Post-hoc analyses at 24-hours post-initial infusion indicated that ketamine was significantly better than passive controls (g = 0.44, 95% CI = 0.03, 0.85), but not active controls (g = 0.24, 95% CI = −0.30, 0.78). Comparisons one-week into intervention suggested no meaningful group differences (g = 0.24, 95% CI = 0.00, 0.48). No significant differences were evident for RCTs that examined effects two-weeks post initial infusion (g = 0.17, 95% CI = −0.10, 0.44).Conclusions: Altogether, ketamine-for-PTSD RCTs reveal a nominal initial therapeutic advantage relative to controls. However, bias and heterogeneity appear problematic. While rapid acting effects were observed, all control agents (including saline) also evidenced rapid acting effects. We argue blind penetration to be a serious concern, and that placebo is the likely mechanism behind reported therapeutic effects. |
| first_indexed | 2024-03-08T13:56:59Z |
| format | Article |
| id | doaj.art-4336dd68f518444dac827fe5faa791c8 |
| institution | Directory Open Access Journal |
| issn | 2000-8066 |
| language | English |
| last_indexed | 2024-03-08T13:56:59Z |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | European Journal of Psychotraumatology |
| spelling | doaj.art-4336dd68f518444dac827fe5faa791c82024-01-15T11:32:26ZengTaylor & Francis GroupEuropean Journal of Psychotraumatology2000-80662024-12-0115110.1080/20008066.2023.2299124So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTsNicholas C. Borgogna0Tyler Owen1Jacob Vaughn2David A. L. Johnson3Stephen L. Aita4Benjamin D. Hill5Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USADepartment of Psychological Sciences, Texas Tech University, Lubbock, TX, USADepartment of Psychological Sciences, Texas Tech University, Lubbock, TX, USADepartment of Psychological Sciences, Texas Tech University, Lubbock, TX, USAVeterans Affairs Maine Healthcare System, Augusta, ME, USADepartment of Psychology, University of South Alabama, Mobile, AL, USAABSTRACTBackground: PTSD is a significant mental health problem worldwide. Current evidence-based interventions suffer various limitations. Ketamine is a novel agent that is hoped to be incrementally better than extant interventions.Objective: Several randomized control trials (RCTs) of ketamine interventions for PTSD have now been published. We sought to systematically review and meta-analyse results from these trials to evaluate preliminary evidence for ketamine’s incremental benefit above-and-beyond control interventions in PTSD treatment.Results: Omnibus findings from 52 effect sizes extracted across six studies (n = 221) yielded a small advantage for ketamine over control conditions at reducing PTSD symptoms (g = 0.27, 95% CI = 0.03, 0.51). However, bias-correction estimates attenuated this effect (adjusted g = 0.20, 95%, CI = −0.08, 0.48). Bias estimates indicated smaller studies reported larger effect sizes favouring ketamine. The only consistent timepoint assessed across RCTs was 24-hours post-initial infusion. Effects at 24-hours post-initial infusion suggest ketamine has a small relative advantage over controls (g = 0.35, 95% CI = 0.06, 0.64). Post-hoc analyses at 24-hours post-initial infusion indicated that ketamine was significantly better than passive controls (g = 0.44, 95% CI = 0.03, 0.85), but not active controls (g = 0.24, 95% CI = −0.30, 0.78). Comparisons one-week into intervention suggested no meaningful group differences (g = 0.24, 95% CI = 0.00, 0.48). No significant differences were evident for RCTs that examined effects two-weeks post initial infusion (g = 0.17, 95% CI = −0.10, 0.44).Conclusions: Altogether, ketamine-for-PTSD RCTs reveal a nominal initial therapeutic advantage relative to controls. However, bias and heterogeneity appear problematic. While rapid acting effects were observed, all control agents (including saline) also evidenced rapid acting effects. We argue blind penetration to be a serious concern, and that placebo is the likely mechanism behind reported therapeutic effects.https://www.tandfonline.com/doi/10.1080/20008066.2023.2299124KetaminePTSDrandomized control trialsmeta-analysisbiasKetamina |
| spellingShingle | Nicholas C. Borgogna Tyler Owen Jacob Vaughn David A. L. Johnson Stephen L. Aita Benjamin D. Hill So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs European Journal of Psychotraumatology Ketamine PTSD randomized control trials meta-analysis bias Ketamina |
| title | So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs |
| title_full | So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs |
| title_fullStr | So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs |
| title_full_unstemmed | So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs |
| title_short | So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs |
| title_sort | so how special is special k a systematic review and meta analysis of ketamine for ptsd rcts |
| topic | Ketamine PTSD randomized control trials meta-analysis bias Ketamina |
| url | https://www.tandfonline.com/doi/10.1080/20008066.2023.2299124 |
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