Self-reported improvements in comorbid post-traumatic stress disorder symptoms, depression, anxiety, and sleep among real-world patients receiving medical ketamine: Exploring the role of adjunct therapies

Introduction: Post-traumatic stress disorder (PTSD) presents severe symptomology and often co-occurs with depression, warranting novel treatment approaches to address both conditions simultaneously. Ketamine has emerged as a rapid antidepressant and potential treatment for PTSD, with some real-world evidence for effectiveness regardless of comorbidities. The purpose of this secondary analysis was to explore the perceived and selfreported outcomes of ketamine treatment in real-world patients with comorbid PTSD. Methods: In an anonymous online survey with quantitative and qualitative items, real-world patients (N = 202) completed measures of depression, anxiety, and sleep disturbance twice, reflecting retrospective pre-ketamine initiation and current symptoms. Patients with comorbid PTSD elaborated on their experiences of changes in symptoms of PTSD. We described subjective experiences regarding PTSD outcomes and potential underlying processes of ketamine's therapeutic effects. We compared patients diagnosed with PTSD versus those without, on pre-ketamine and current depression, anxiety, and sleep. Results: Participants with comorbid PTSD (n = 98) described improvements in multiple PTSD symptoms. They reported more severe/frequent depression, anxiety, and sleep disturbance prior to ketamine compared to patients without PTSD (ps<0.017) but responded to ketamine just as well, with no differences in current scores (ps>0.259). Most PTSD patients reported receiving adjunct therapy, mostly psychotherapy, however, similar improvements were also reported by those receiving none. Discussion: As perceived by real-world patients, ketamine successfully improved an array of symptoms and allowed reprocessing of the trauma. Targeted longitudinal and qualitative research is needed in larger, more diverse samples on the role and effects of other adjunct psychological and somatic therapies to inform and optimize PTSD treatment protocols.