So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs ¿Entonces qué tan especial es la K? Una revisión sistematizada y metanálisis de la Ketamina para ECAs en el TEPT

dc.creatorBorgogna, Nicholas C. (TTU)
dc.creatorOwen, Tyler (TTU)
dc.creatorVaughn, Jacob (TTU)
dc.creatorJohnson, David A.L. (TTU)
dc.creatorAita, Stephen L.
dc.creatorHill, Benjamin D.
dc.date.accessioned2024-02-21T21:22:16Z
dc.date.available2024-02-21T21:22:16Z
dc.date.issued2024
dc.description© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. cc-by-nc
dc.description.abstractBackground: PTSD is a significant mental health problem worldwide. Current evidence-based interventions suffer various limitations. Ketamine is a novel agent that is hoped to be incrementally better than extant interventions. Objective: Several randomized control trials (RCTs) of ketamine interventions for PTSD have now been published. We sought to systematically review and meta-analyse results from these trials to evaluate preliminary evidence for ketamine’s incremental benefit above-and-beyond control interventions in PTSD treatment. Results: Omnibus findings from 52 effect sizes extracted across six studies (n = 221) yielded a small advantage for ketamine over control conditions at reducing PTSD symptoms (g = 0.27, 95% CI = 0.03, 0.51). However, bias-correction estimates attenuated this effect (adjusted g = 0.20, 95%, CI = −0.08, 0.48). Bias estimates indicated smaller studies reported larger effect sizes favouring ketamine. The only consistent timepoint assessed across RCTs was 24-hours post-initial infusion. Effects at 24-hours post-initial infusion suggest ketamine has a small relative advantage over controls (g = 0.35, 95% CI = 0.06, 0.64). Post-hoc analyses at 24-hours post-initial infusion indicated that ketamine was significantly better than passive controls (g = 0.44, 95% CI = 0.03, 0.85), but not active controls (g = 0.24, 95% CI = −0.30, 0.78). Comparisons one-week into intervention suggested no meaningful group differences (g = 0.24, 95% CI = 0.00, 0.48). No significant differences were evident for RCTs that examined effects two-weeks post initial infusion (g = 0.17, 95% CI = −0.10, 0.44). Conclusions: Altogether, ketamine-for-PTSD RCTs reveal a nominal initial therapeutic advantage relative to controls. However, bias and heterogeneity appear problematic. While rapid acting effects were observed, all control agents (including saline) also evidenced rapid acting effects. We argue blind penetration to be a serious concern, and that placebo is the likely mechanism behind reported therapeutic effects.
dc.identifier.citationBorgogna, N.C., Owen, T., Vaughn, J., Johnson, D.A.L., Aita, S.L., & Hill, B.D.. 2024. So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs ¿Entonces qué tan especial es la K? Una revisión sistematizada y metanálisis de la Ketamina para ECAs en el TEPT. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2023.2299124
dc.identifier.urihttps://doi.org/10.1080/20008066.2023.2299124
dc.identifier.urihttps://hdl.handle.net/2346/97618
dc.language.isoeng
dc.subjectbias
dc.subjectKetamine
dc.subjectmeta-analysis
dc.subjectPTSD
dc.subjectrandomized control trials
dc.titleSo how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs ¿Entonces qué tan especial es la K? Una revisión sistematizada y metanálisis de la Ketamina para ECAs en el TEPT
dc.typeReview

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