In a retrospective case series, veterans with treatment-resistant depression and PTSD saw their depression scores fall across both the nasal-spray and the intravenous ketamine they received — with no head-to-head comparison.
A 2022 retrospective case series looked back at the records of 15 veterans with treatment-resistant depression and PTSD who switched from nasal-spray esketamine to intravenous ketamine.
This retrospective case series reviewed 15 veterans with hard-to-treat depression and PTSD at a VA clinic who switched from at least six nasal-spray esketamine treatments to intravenous racemic ketamine. Depression scores fell across the ketamine treatments, and the authors suggest IV ketamine as a reasonable next step for people who don't respond adequately to the FDA-approved nasal-spray form. Because it's an uncontrolled chart review with no randomized head-to-head comparison, it can't establish that IV is superior — the authors call for controlled trials.
This retrospective case series analyzed 15 veterans with comorbid treatment-resistant depression and PTSD who received at least six intranasal (S)-ketamine treatments before switching to IV racemic ketamine at a VA clinic. Across both formulations, veterans showed significant reductions in depression (PHQ-9). The authors position IV racemic ketamine as a reasonable next step for inadequate responders to intranasal (S)-ketamine.
This is an uncontrolled, retrospective chart review (n=15) with no randomization and no head-to-head comparison, so it cannot establish that IV racemic ketamine is more effective than intranasal (S)-ketamine — only that depression improved in this small, selected group. The authors explicitly call for double-blind randomized controlled trials.
It complements a real-world VA series of intranasal (S)-ketamine in veterans with comorbid depression and PTSD (Artin et al., 2022), and sits against the largest randomized military ketamine trial, which found no PTSD benefit over placebo (Abdallah et al., 2022).
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