Is Ketamine Effective for treating PTSD?

Like many of you, I have been hearing about Ketamine in the treatment of PTSD. Also like many of you, I’ve wondered how effective it actually is in treating it. I’ve been doing some research to see if it would a helpful treatment for trauma or not. I’ll share with you what I found, along with links so you can see the research for yourself if you would like.

First, know there are two significant forms of Ketamine. One is the IV form of Ketamine (you are given a shot), which is the most commonly offered kind of treatment, but it is also offered in a lozenge form. There is also esketamine (Spravato), which is offered for treatment-resistant depression. Esketamine does not have much evidence that it does anything for trauma, but it is FDA approved for treating depression.

Neither medication is FDA approved for the treatment of PTSD; when IV Ketamine is given for trauma, it is given off-label. This is not unusual, many drugs are given off-label. What’s the evidence that either of them work? That matters more to me.

I will share the strongest research available regarding IV Ketamine. Randomized Control Trials are some of the the strongest kind of research scientists do. The best-known randomized trial (30 participants), was conducted in 2021. It showed that two weeks of IV ketamine reduced PTSD symptoms in roughly two-thirds of participants, compared with one-fifth on an inactive control. Thirty participants isn’t a large number, but it showed significant results.

More recently, a 2024 meta-analysis (a study that combines results from studies) pooled every randomized study found this benefit is real but modest overall, and it tends to fade after a month. That last part is important. Because existing trials are few, short, and vary in quality, the 2023 VA/DoD guideline advises against routine ketamine use for PTSD until larger studies confirm lasting benefit.

How about side effects? Both drugs can cause brief dizziness, nausea, increases in blood pressure, and dissociation; esketamine users occasionally report trauma flashbacks, which can be unsettling but usually pass within hours under supervision.

Esketamine (Spravato) is more likely to be covered by insurance because it is FDA-approved for depression. IV ketamine is often cheaper per dose but is rarely reimbursed and still needs a monitored infusion setting.

How about ketamine in its lozenge form? There is emerging evidence that sublingual ketamine lozenges can reduce PTSD symptoms, but it comes from small case reports, retrospective chart reviews, and open‑label programs rather than randomized controlled trials. Most supportive studies combine sublingual dosing with psychotherapy, making it hard to isolate the drug effect from the therapy effect.

My final recommendation: anyone considering either option for ketamine (IV or lozenge) should view them as experimental for trauma and discuss risks, cost, and alternative therapies—especially the gold-standard trauma-focused psychotherapies—with a qualified clinician.