Combining Esketamine and Prolonged Exposure Treatment for PTSD (Post Traumatic Stress Disorder)

Exclusion Criteria

• •1. Young adults (18-24) currently taking any antidepressant.
• •2. Lifetime history of psychotic disorder or history of significant psychotic symptoms.
• •3. Lifetime history of manic episode.
• •4. Moderate or greater severity for alcohol or substance use disorder (DSM-5) in the previous six months.
• •5. A history of ketamine or phencyclidine abuse.
• •6. Evidence of a traumatic brain injury severe enough to interfere with comprehension and responding to the baseline screening questionnaires.
• •7. Current suicidal ideation severe enough to warrant immediate attention (as determined by the Depressive Symptoms Index-Suicidality Subscale and corroborated by a clinical risk assessment by a credentialed provider)
• •8. Other psychiatric disorders severe enough to warrant designation as the primary disorder as determined by clinician judgment.
• •9. Current use (with past 4 weeks) of any prohibited concomitant medications
• •10. Benzodiazepines, other medications, sedatives, acute alcohol use, or recreational drug use that would put patients at risk in the judgment of clinical providers).
• •11. Planned use of ketamine (i.e., for pain control) or participation in another trauma-focused psychotherapy during the time of the study.
• •12. Uncontrolled hypertension or tachycardia
• •13. A history of sensitivity or adverse reaction to ketamine or its excipients
• •14. An unstable medical, cardiovascular, pulmonary, or neurological condition that the investigator considers a contraindication to ketamine administration
• •15. Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation.
• •16. Intracerebral hemorrhage.
• •17. Pregnancy or breastfeeding; women of childbearing potential unwilling to utilize reliable methods of contraception
• •18. History of nasal surgery or nasal obstructions experienced as an adult.
• •19. Inability to arrange for assisted transportation on ketamine treatment days due to recommendation that patient not drive for the remainder of the day following a ketamine treatment.