Ketamine, an N-methyl-D-aspartate–type glutamate receptor antagonist, has long been used for anesthesia and has recently been investigated for its rapid antidepressant effects in adults with treatment-resistant depression and posttraumatic stress disorder (PTSD). We report a case of a child with PTSD and episodes of severe aggression and emotional dysregulation that were refractory to multiple medical and behavioral interventions. This child demonstrated sustained (8–13 days) remission from these symptoms when exposed to ketamine in the context of 2 procedures. We review the sparse literature on the uses of ketamine for behavioral purposes in children. This case suggests that ketamine should be further explored as a potential treatment option for children with severe refractory behavioral aggression.
Severe behavioral dysregulation in children and adolescents is often difficult to treat, especially in the setting of a history of traumatic early experiences such as child abuse. When children’s behavioral disorders are most severe, they often require treatment in a residential setting. This is not ideal in patients like the boy presented here who have disrupted attachment relationships with their caregivers, for whom treatment focuses on fostering the caregiver-child attachment relationship; out-of-home placement inhibits the progress of this treatment goal. Given this situation, novel treatments are urgently needed for children with trauma histories who have severe and treatment-resistant behavioral problems.
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