Esketamine facilitate psychotherapies for Post-Traumatic stress disorder: A retrospective case series of six patients

medication-enhanced psychotherapies are increasingly used to treat Post Traumatic Stress Disorder (PTSD). Esketamine, used in patients with treatment-resistant depression (TRD), sounds very promising as a new treatment for PTSD. Thus, our main objective was to investigate whether Esketamine associated with psychotherapy could reduce symptoms of both depression and PTSD in patients with complex PTSD. We retrospectively collected clinical data of 6 patients receiving Esketamine nasal spray for TRD with comorbid PTSD. This treatment was always associated with a psychotherapy (supportive therapy, EMDR or hypnosis) and was prescribed twice then once per week during 24 weeks. During the different sessions, five patients exhibited a clear improvement in depression and the MADRS score decreased by an average of 12.6 points. For PTSD, all patients presented a clear reduction of their PCL-5 scores ranging from -10.5 to -46.5 points. Moreover, we observed that 3 different sub-scores of the PCL-5 (re-experiencing, negative alteration of cognition and mood and hyper arousal) decreased significantly during sessions, but it was not the case for the avoidance sub-score. Esketamine treatment associated with psychotherapies appears promising in patients with resistant complex PTSD and TRD. However, these encouraging results need to be confirmed in a standardized study with a larger sample size.