Repeated Ketamine Infusions for Comorbid PTSD and MDD in Veterans

Inclusion Criteria:

For the PTSD+MDD group, inclusion criteria are:

1. Female/Male veterans
2. 18 to 75 years old
3. Meets DSM-5 criteria for MDD, single or recurrent, moderate-severe without psychotic features
4. Meets DSM-5 criteria for chronic PTSD or subthreshold PTSD \[meets criterion A (traumatic event), criterion B (intrusion symptoms), and 2 of the following 3 criteria: C (avoidance symptoms), D (negative alterations in cognitions and mood), or E (marked alterations in arousal and reactivity)\]
5. If applicable, 6 weeks of stable antidepressants/augmenting agents
6. Sixth grade reading level
7. Ability to provide consent

For the Healthy Controls group, inclusion criteria are:

1. Female/Male veterans
2. 18 to 75 years old
3. Does not meet DSM-5 criteria for MDD, single or recurrent, moderate-severe without psychotic features
4. Does not meet DSM-5 criteria for chronic PTSD or subthreshold PTSD
5. Not on medications for managing a psychiatric indication
6. Sixth grade reading level
7. Ability to provide consent

For the Depression-only group, inclusion criteria are:

1. Female/Male veterans
2. 18 to 75 years old
3. Experienced a traumatic event that meets DSM-5 criterion A for a diagnosis of PTSD but does not meet sufficient criteria (B-E) necessary for a diagnosis of PTSD or subthreshold PTSD
4. Meets criteria for MDD, single or recurrent, moderate-severe
5. If applicable, 6 weeks of stable antidepressants/augmenting agents
6. Sixth grade reading level
7. Ability to provide consent

For the PTSD-only group, inclusion criteria are:

1. Female/Male veterans
2. 18 to 75 years old
3. Meets DSM-5 criteria for chronic PTSD or subthreshold PTSD \[meets criterion A (traumatic event), criterion B (intrusion symptoms), and 2 of the following 3 criteria: C (avoidance symptoms), D (negative alterations in cognitions and mood), or E (marked alterations in arousal and reactivity)\]
4. Does not meet DSM-5 criteria for MDD, single or recurrent, moderate-severe without psychotic features
5. If applicable, 6 weeks of stable antidepressants/augmenting agents
6. Sixth grade reading level
7. Ability to provide consent

Exclusion Criteria:

For the PTSD+MDD group, exclusion criteria are:

1. Inability or unwillingness to provide written informed consent
2. Moderate/severe cognitive impairment
3. Current or lifetime diagnosis of psychosis-related disorder, bipolar I or II disorder, substance-induced mood disorder, or any mood disorder due to a general medical condition
4. History of moderate or severe traumatic brain injury
5. History of comorbid substance disorder within 1 month of screening
6. Prior use of ketamine as an antidepressant
7. Clinically unstable medical illness
8. For women: pregnancy (confirmed by baseline lab test), the initiation of female hormonal treatments within 3 months of screening, or inability or unwillingness to use a medically accepted contraceptive method for the duration of the study
9. Imminent risk of suicidal/homicidal ideation and/or behavior
10. Inability to undergo MRI (i.e. claustrophobia, ferromagnetic implants, etc.)

For the Healthy Controls group, exclusion criteria are:

1. Inability or unwillingness to provide written informed consent
2. Moderate/severe cognitive impairment
3. History of any major medical or psychiatric disorders
4. Current or lifetime diagnosis of psychosis-related disorder, bipolar I or II disorder, substance-induced mood disorder, or any mood disorder due to a general medical condition
5. History of moderate or severe traumatic brain injury
6. History of comorbid substance disorder within 1 month of screening
7. Prior use of ketamine as an antidepressant
8. Clinically unstable medical illness
9. For women: pregnancy (confirmed by baseline lab test), the initiation of female hormonal treatments within 3 months of screening, or inability or unwillingness to use a medically accepted contraceptive method for the duration of the study
10. Imminent risk of suicidal/homicidal ideation and/or behavior
11. Inability to undergo MRI (i.e. claustrophobia, ferromagnetic implants, etc.)

For the Depression-only group, exclusion criteria are:

1. Inability or unwillingness to provide written informed consent
2. Moderate/severe cognitive impairment
3. Meet DSM-5 criteria for PTSD or subthreshold PTSD
4. Current or lifetime diagnosis of psychosis-related disorder, bipolar I or II disorder, substance-induced mood disorder, or any mood disorder due to a general medical condition
5. History of moderate or severe traumatic brain injury
6. History of comorbid substance disorder within 1 month of screening
7. Prior use of ketamine as an antidepressant
8. Clinically unstable medical illness
9. For women: pregnancy (confirmed by baseline lab test), the initiation of female hormonal treatments within 3 months of screening, or inability or unwillingness to use a medically accepted contraceptive method for the duration of the study
10. Imminent risk of suicidal/homicidal ideation and/or behavior
11. Inability to undergo MRI (i.e. claustrophobia, ferromagnetic implants, etc.)

For the PTSD-only group, exclusion criteria are:

1. Inability or unwillingness to provide written informed consent
2. Moderate/severe cognitive impairment
3. Meet DSM-5 criteria for a diagnosis of MDD, single or recurrent, moderate to severe
4. Current or lifetime diagnosis of psychosis-related disorder, bipolar I or II disorder, substance-induced mood disorder, or any mood disorder due to a general medical condition
5. History of moderate or severe traumatic brain injury
6. History of comorbid substance disorder within 1 month of screening
7. Prior use of ketamine as an antidepressant
8. Clinically unstable medical illness
9. For women: pregnancy (confirmed by baseline lab test), the initiation of female hormonal treatments within 3 months of screening, or inability or unwillingness to use a medically accepted contraceptive method for the duration of the study
10. Imminent risk of suicidal/homicidal ideation and/or behavior
11. Inability to undergo MRI (i.e. claustrophobia, ferromagnetic implants, etc.)