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Ketamine as a Treatment for Post-Traumatic Stress Disorder (PTSD)

Primary Purpose

Posttraumatic Stress Disorder (PTSD)

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Ketamine
Midazolam
Sponsored by
Icahn School of Medicine at Mount Sinai
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Posttraumatic Stress Disorder (PTSD) focused on measuring posttraumatic stress disorder, PTSD, ketamine, trauma, treatment, New York, NYC

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Men or women, 18-65 years of age;
  • Participants must have a level of understanding sufficient to agree to all tests and examinations required by the protocol and must sign a written informed consent document;
  • Participants must fulfill DSM-5 criteria for current civilian or combat-related PTSD
  • Women must be using a medically accepted reliable means of contraception (if using an oral contraceptive medication, they must also be using a barrier contraceptive) or not be of childbearing potential (i.e., surgically sterile, postmenopausal for at least one year);
  • Women of childbearing potential must have a negative pregnancy test at screening and prior to each intravenous infusion;
  • Participants must be able to identify a family member, physician, or friend (i.e. someone who knows them well) who will participate in a Treatment Contract (and e.g. contact the study physician on their behalf in case manic symptoms or suicidal thoughts develop).

Exclusion criteria:

  • Women who plan to become pregnant, are pregnant or are breast-feeding
  • Serious, unstable medical illnesses such as hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, neurologic, immunologic, or hematologic disease, including gastro-esophageal reflux disease, obstructive sleep apnea, history of difficulty with airway management during previous anesthetics, ischemic heart disease and uncontrolled hypertension, and history of severe head injury;
  • Clinically significant abnormal findings of laboratory parameters, physical examination, or ECG;
  • Renal impairment, as reflected by a BUN >20 mg/dL, and/or creatinin clearance of >1.3 mg/dL;
  • Thyroid impairment, as reflected by TSH> 4.2 mU/L Patients with uncorrected hypothyroidism or hyperthyroidism;
  • Hormonal treatment (e.g., estrogen) started in the 3 months prior to the first infusion day;
  • Use of evidence-based individual psychotherapy (such as prolonged exposure) during the study;
  • History of autism, mental retardation, pervasive developmental disorders, or Tourette's syndrome; History of one or more seizures without a clear and resolved etiology;
  • History of (hypo)mania;
  • Past or current presence of psychotic symptoms, or diagnosis of a lifetime psychotic disorder including schizophrenia or schizoaffective disorder;
  • Drug or alcohol abuse or dependence within the preceding 3 months
  • Previous recreational use of ketamine or PCP;
  • Current diagnosis of bulimia nervosa or anorexia nervosa;
  • Diagnosis of schizotypal or antisocial personality disorder
  • Patients judged clinically to be at serious and imminent suicidal or homicidal risk.
  • A blood pressure of one reading over 160/90 or two separate readings over 140/90 at screen or baseline visits
  • Patients who report current treatment with a benzodiazepine, an opioid medication, or a mood stabilizer (such as valproic acid or lithium) within 2 weeks prior to randomization

Sites / Locations

  • Depression and Anxiety Center (DAC)

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Experimental ketamine group

Active control midazolam group

Arm Description

This arm will receive 0.5mg/kg repeated dose ketamine (6 infusions, 3 per week for 2 weeks).

This arm will receive 0.045mg/kg repeated dose midazolam (6 infusions, 3 per week for 2 weeks).

Outcomes

Primary Outcome Measures

Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
full range score from 0-80, with higher scores indicating greater PTSD symptoms

Secondary Outcome Measures

The Impact of Event Scale - Revised (IES-R)
full range score from 0-88, with higher scores indicating greater PTSD symptoms
Montgomery Asberg Depression Rating Scale (MADRS)
full range score from 0-60, with higher scores indicating greater depressive symptoms
Montgomery Asberg Depression Rating Scale (MADRS)
full range score from 0-60, with higher scores indicating greater depressive symptoms
Quick Inventory of Depression Symptomatology - Self-Report (QIDS-SR)
full range score from 0-27, with higher scores indicating greater depressive symptoms
Number of Participants With Patient-Rated Inventory of Side Effects (PRISE)
All side effects listed in Adverse Event section.

Full Information

First Posted
March 19, 2015
Last Updated
February 16, 2021
Sponsor
Icahn School of Medicine at Mount Sinai
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1. Study Identification

Unique Protocol Identification Number
NCT02397889
Brief Title
Ketamine as a Treatment for Post-Traumatic Stress Disorder (PTSD)
Official Title
Randomized Controlled Trial of Repeated-Dose Intravenous Ketamine for PTSD
Study Type
Interventional

2. Study Status

Record Verification Date
February 2021
Overall Recruitment Status
Completed
Study Start Date
May 18, 2015 (undefined)
Primary Completion Date
January 27, 2020 (Actual)
Study Completion Date
January 27, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Icahn School of Medicine at Mount Sinai

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to study new ways to treat post-traumatic stress disorder (PTSD). Current treatments for PTSD do not work for everyone and it can take time to determine whether a person responds to a chosen treatment. The purpose of this study is to see whether ketamine, when given repeatedly intravenously can produce a quick and persistent improvement in PTSD symptoms. At higher doses, ketamine has been used for many years as an anesthetic for medical procedures, and at lower doses may be an effective treatment in patients with major depression and PTSD. Ketamine given for PTSD is investigational, which means that the FDA has not yet approved the drug for treating this condition. In this study, the effects of ketamine will be compared to those of midazolam. Midazolam has similar acute anesthetic effects compared to ketamine but has not been shown to treat or alleviate any symptoms of PTSD. This makes midazolam an appropriate substance to gauge whether ketamine can treat or alleviate PTSD symptoms thereby acting as what we call an active control.
Detailed Description
Ketamine is an approved medication in several countries for the induction of general anesthesia and for use as adjunct to other anesthetics. Intravenous ketamine is being developed and tested for the treatment of posttraumatic stress disorder (PTSD). All subjects will be administered the study medication by the study anesthesiologists and under the direct supervision of the investigator or designee. On all dosing days, all subjects must remain at the clinical site until at least 4 hours post-dose (or longer if required for study procedures) and will be accompanied by a responsible adult when discharged from the clinical site. The end of study will occur when the last subject in the trial completes his/her last study assessment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Posttraumatic Stress Disorder (PTSD)
Keywords
posttraumatic stress disorder, PTSD, ketamine, trauma, treatment, New York, NYC

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Experimental ketamine group
Arm Type
Experimental
Arm Description
This arm will receive 0.5mg/kg repeated dose ketamine (6 infusions, 3 per week for 2 weeks).
Arm Title
Active control midazolam group
Arm Type
Active Comparator
Arm Description
This arm will receive 0.045mg/kg repeated dose midazolam (6 infusions, 3 per week for 2 weeks).
Intervention Type
Drug
Intervention Name(s)
Ketamine
Other Intervention Name(s)
Generic only
Intervention Description
This arm will receive 0.5mg/kg repeated dose ketamine (6 intravenous infusions, 3 per week for 2 weeks).
Intervention Type
Drug
Intervention Name(s)
Midazolam
Other Intervention Name(s)
Generic only
Intervention Description
This arm will receive 0.045mg/kg repeated dose intravenous midazolam (6 intravenous infusions, 3 per week for 2 weeks).
Primary Outcome Measure Information:
Title
Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)
Description
full range score from 0-80, with higher scores indicating greater PTSD symptoms
Time Frame
2 weeks after the first infusion
Secondary Outcome Measure Information:
Title
The Impact of Event Scale - Revised (IES-R)
Description
full range score from 0-88, with higher scores indicating greater PTSD symptoms
Time Frame
24 hours after the first drug infusion
Title
Montgomery Asberg Depression Rating Scale (MADRS)
Description
full range score from 0-60, with higher scores indicating greater depressive symptoms
Time Frame
24 hours after the first drug infusion
Title
Montgomery Asberg Depression Rating Scale (MADRS)
Description
full range score from 0-60, with higher scores indicating greater depressive symptoms
Time Frame
2 weeks after the first drug infusion
Title
Quick Inventory of Depression Symptomatology - Self-Report (QIDS-SR)
Description
full range score from 0-27, with higher scores indicating greater depressive symptoms
Time Frame
2 weeks after the first drug infusion
Title
Number of Participants With Patient-Rated Inventory of Side Effects (PRISE)
Description
All side effects listed in Adverse Event section.
Time Frame
up to 21 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men or women, 18-65 years of age; Participants must have a level of understanding sufficient to agree to all tests and examinations required by the protocol and must sign a written informed consent document; Participants must fulfill DSM-5 criteria for current civilian or combat-related PTSD Women must be using a medically accepted reliable means of contraception (if using an oral contraceptive medication, they must also be using a barrier contraceptive) or not be of childbearing potential (i.e., surgically sterile, postmenopausal for at least one year); Women of childbearing potential must have a negative pregnancy test at screening and prior to each intravenous infusion; Participants must be able to identify a family member, physician, or friend (i.e. someone who knows them well) who will participate in a Treatment Contract (and e.g. contact the study physician on their behalf in case manic symptoms or suicidal thoughts develop). Exclusion criteria: Women who plan to become pregnant, are pregnant or are breast-feeding Serious, unstable medical illnesses such as hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, neurologic, immunologic, or hematologic disease, including gastro-esophageal reflux disease, obstructive sleep apnea, history of difficulty with airway management during previous anesthetics, ischemic heart disease and uncontrolled hypertension, and history of severe head injury; Clinically significant abnormal findings of laboratory parameters, physical examination, or ECG; Renal impairment, as reflected by a BUN >20 mg/dL, and/or creatinin clearance of >1.3 mg/dL; Thyroid impairment, as reflected by TSH> 4.2 mU/L Patients with uncorrected hypothyroidism or hyperthyroidism; Hormonal treatment (e.g., estrogen) started in the 3 months prior to the first infusion day; Use of evidence-based individual psychotherapy (such as prolonged exposure) during the study; History of autism, mental retardation, pervasive developmental disorders, or Tourette's syndrome; History of one or more seizures without a clear and resolved etiology; History of (hypo)mania; Past or current presence of psychotic symptoms, or diagnosis of a lifetime psychotic disorder including schizophrenia or schizoaffective disorder; Drug or alcohol abuse or dependence within the preceding 3 months Previous recreational use of ketamine or PCP; Current diagnosis of bulimia nervosa or anorexia nervosa; Diagnosis of schizotypal or antisocial personality disorder Patients judged clinically to be at serious and imminent suicidal or homicidal risk. A blood pressure of one reading over 160/90 or two separate readings over 140/90 at screen or baseline visits Patients who report current treatment with a benzodiazepine, an opioid medication, or a mood stabilizer (such as valproic acid or lithium) within 2 weeks prior to randomization
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Adriana Feder, MD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Depression and Anxiety Center (DAC)
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33397139
Citation
Feder A, Costi S, Rutter SB, Collins AB, Govindarajulu U, Jha MK, Horn SR, Kautz M, Corniquel M, Collins KA, Bevilacqua L, Glasgow AM, Brallier J, Pietrzak RH, Murrough JW, Charney DS. A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder. Am J Psychiatry. 2021 Feb 1;178(2):193-202. doi: 10.1176/appi.ajp.2020.20050596. Epub 2021 Jan 5.
Results Reference
derived

Learn more about this trial

Ketamine as a Treatment for Post-Traumatic Stress Disorder (PTSD)

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