Evidence map›Paper›PMID 40287566›Full record

ArticleCNS drugs2025

Impact of Medical Comorbidities on Ketamine and Esketamine Treatment Effectiveness for Posttraumatic Stress Disorder and Depression: A Clinical Outcomes Analysis from the VA San Diego Healthcare System.

Sijia Zhang, Houtan Afshar, Peter J Colvonen, Brandon Nokes, Jason Compton, Jyoti Mishra, Andrew W Bismark, Dhakshin S Ramanathan, Miranda F Koloski

Abstract read
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In one paragraph

Article in CNS drugs, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Ketamine or Esketamine in Special Populations of Patients With Treatment-Resistant Depression.Medical science monitor : international medical journal of experimental and clinical research · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Sijia ZhangVA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.ORCID 0009-0003-0617-8619
Houtan AfsharVA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.ORCID 0009-0000-3101-5297
Peter J ColvonenVA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.ORCID 0000-0003-0222-8781
Brandon NokesVA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.ORCID 0000-0003-3515-7545
Jason ComptonVA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.ORCID 0009-0004-3058-6783
Jyoti MishraVA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.ORCID 0000-0001-6612-4557
Andrew W BismarkVA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.ORCID 0000-0003-0381-642X
Dhakshin S Ramanathan *VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. dramanathan@health.ucsd.edu.ORCID 0000-0002-5212-3067
Miranda F Koloski *VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. mfrancoeur@health.ucsd.edu.ORCID 0000-0001-5694-8122

Funding

BLRD VA IK2 BX006125
6 · The paper itself

Abstract

backgroundKetamine and esketamine are increasingly used to manage treatment-resistant depression and have also been shown to reduce symptoms of posttraumatic stress disorder (PTSD). Little is known about how common comorbidities in the veteran population, such as traumatic brain injury (TBI) or obstructive sleep apnea (OSA), may influence ketamine and esketamine treatment outcomes.

methodsIn this retrospective study, we analyzed clinical outcomes from Veterans Affairs (VA) San Diego Healthcare System's ketamine program to assess the relationship between ketamine or esketamine treatment and changes in depression and PTSD symptoms, while also examining how common medical comorbidities influence treatment outcomes. We specifically examined whether a patient's history of TBI or OSA would affect ketamine or esketamine treatment outcomes. Linear mixed-effects models were used to examine how TBI and OSA history interacted with ketamine/esketamine treatment to change PTSD Checklist for DSM-5 (PCL-5) and Patient Health Questionnaire-9 (PHQ-9) scores.

resultsThis study included 119 veterans who received eight sessions of ketamine or esketamine treatment at the San Diego VA Medical Center. Using linear effects modeling, we found that repeated ketamine or esketamine sessions were significantly correlated with reductions in both depression (p < 0.005) and PTSD (p < 0.05) symptom scores. However, in veterans with comorbid TBI (n = 38) and severe OSA (n = 9), depression symptoms did not improve over the course of ketamine or esketamine treatment, suggesting this subgroup may require alternative treatments or OSA treatment prior to starting ketamine or esketamine treatment.

conclusionsKetamine and esketamine treatment did not improve symptoms of depression in veterans with comorbid TBI and severe OSA. Thus, our findings generally support ketamine and esketamine as effective interventions for depression and PTSD, while emphasizing the consideration of comorbidities such as OSA and TBI.

Indexed as

Antidepressive AgentsDepressionKetamineStress Disorders, Post-TraumaticAdultAgedBrain Injuries, TraumaticCaliforniaComorbidityDepressive Disorder, Treatment-ResistantFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeAntidepressive AgentsEsketamineKetamine

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.