In a retrospective case series at a VA clinic, veterans with both depression and PTSD had lower PTSD and depression scores over their first weeks of nasal-spray ketamine.
A 2022 retrospective case series looked back at VA clinic records for 35 veterans who had both depression and PTSD and were treated with a nasal-spray form of ketamine (esketamine).
This retrospective review looked back at the records of 35 veterans with both depression and PTSD who were treated with intranasal esketamine — a nasal-spray form of ketamine — at a VA clinic. Over the first eight treatments (about four weeks), average PTSD scores fell by roughly a quarter, and about half the veterans had a meaningful drop in PTSD; depression also eased, though fewer reached a meaningful response. Because this was an uncontrolled look back at clinic records, not a randomized trial, it can't separate the drug's effect from expectation, and the authors call for formal controlled studies.
This open-label retrospective case series reviewed outcomes for 35 veterans with comorbid depression and PTSD treated with intranasal (S)-ketamine at a VA clinic; veterans were not randomized or blinded. Across the first eight treatments, PTSD (PCL-5) fell from 54.8 to 39.3 with 46% meeting a clinically meaningful response, and depression (PHQ-9) from 19.8 to 14.7 with 14% meeting response. PTSD and depression changes were temporally and individually distinct.
As a retrospective, uncontrolled chart review, this is hypothesis-generating rather than confirmatory: no control group, no randomization, no blinding, and outcomes from routine clinical records, so placebo response and selection effects cannot be excluded. The sample is modest (n=35). The authors explicitly frame it as warranting formal randomized controlled studies.
Esketamine is FDA-approved for treatment-resistant depression but not for PTSD; this real-world VA series is among observations suggesting a possible PTSD signal. It should be weighed against the largest randomized, placebo-controlled military ketamine trial, which found no PTSD benefit over placebo (Abdallah et al., 2022).
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