Could Ketamine Be the Next Therapy for Behavioral Dysregulation in Children With PTSD?
Abstract
After receiving ketamine for two medical procedures, a boy with PTSD and extreme behavioral dysregulation showed behavioral improvements.
Chance observations of the effects of medications prescribed for other purposes have often led to the discovery of their psychiatric applications. The use of stimulants for attention-deficit/hyperactivity disorder or the adaptation of an antihistamine into chlorpromazine are just two examples of this phenomenon.
Karen Cullen, M.D., believes that substantial research must be done to prove that ketamine could be a safe and effective treatment for children with behavioral dysregulation and posttraumatic stress disorder who have not responded to more standard interventions.
Recently, researchers from the University of Minnesota presented a hypothesis-generating case report describing how ketamine, an anesthetic now being studied for its antidepressant effects, was associated with symptomatic improvement in a 7-year-old boy with posttraumatic stress disorder (due to child abuse) and extreme behavioral dysregulation.
The boy exhibited such severe outbursts that he was placed in a long-term residential facility and often required physical restraints, Anna Donoghue, M.D., a PGY-1 resident in psychiatry at the University of Minnesota, and colleagues reported online August 10 in the journal Pediatrics.
According to the researchers, the child’s symptoms were refractory to multiple medical and behavioral interventions, such as antidepressants, stimulants, alpha-2 agonist medications, histamine, modulators, and mood stabilizers.
However, after receiving 10 mg of ketamine twice (once for a tonsillectomy and later for magnetic resonance imaging), caregivers noted that the boy’s symptoms remitted (for 13 days after the first occasion and for eight days after the second). During these periods of remission, he also proved more responsive to psychotherapy, something that had never happened before, the researchers reported.
“There has been increasing interest in the potential use of low, subanesthetic doses of ketamine for the treatment of psychiatric disorders,” Kathryn Cullen, M.D., division chief of child and adolescent psychiatry at the University of Minnesota and a study coauthor, told Psychiatric News. “But most of the psychiatric research to date, however, has been in adults.”
Cullen said that the boy’s family contacted the researchers after hearing about ketamine as a possible treatment for adolescents with treatment-resistant depression. The parents were in pursuit of a physician who could provide ketamine to the 7-year-old on an ongoing basis; Cullen and her colleagues declined this request.
“Although the results presented in this case report are very promising with remarkable features as it relates to ketamine’s ability to reverse severe aggression in a child with PTSD on two separate occasions, many questions remain about the safety and efficacy of using repeated doses of ketamine for chronic behavioral problems in children,” said Cullen.
“Ketamine is an anesthetic agent that bears significant risks and requires careful monitoring,” she emphasized. “Substantial research is needed before any recommendations can be made about broad clinical use for this purpose in children.”
The researchers are unclear about just how ketamine might have led to the child’s behavioral improvements. In the paper, they speculated that the drug might have increased neuroplasticity that could have played a role in unlocking neural pathways damaged from early trauma, “opening the door for the possibility of recovery through engagement in therapy.”
Cullen concluded that she is hopeful that other researchers who read the case report will be inspired to consider research in this area. ■
