Mindpath Health’s Julian Lagoy, M.D. helps discuss Ketamine therapy for anxiety.
Ketamine was originally developed in the 1950sTrusted Source and used in the 1960s as a general anesthetic for medical procedures due to its pain-reducing and sedative effects. In recent years, though, researchers have started investigating the potential benefits of ketamine for treating certain mental health conditions, including anxiety, depression, and post-traumatic stress disorder.
While there are a variety of medications used to treat anxiety, research suggests around 50% of people undergoing treatment for generalized anxiety disorder (GAD) are “treatment-resistant.” That means they don’t experience any improvement after a course of anti-anxiety medication.
An increasing number of experts believe ketamine might be an effective alternative for treating anxiety that doesn’t respond to other approaches.
The FDA has only approved a particular form of ketamine for treatment-resistant depression, not anxiety. However, doctors may still prescribe ketamine “off-label” to treat anxiety. This is known as ketamine therapy, and the research on its potential benefits has been steadily growing.
Here’s a closer look at how ketamine therapy may help with anxiety, the risks involved, and how to find a qualified mental health professional who can administer ketamine therapy.
How it works
According to Khaled Bowarshi, MD, a psychiatrist at Florida TMS Clinic, ketamine works by quickly increasing the activity of glutamate in the brain.
Glutamate is one of the brain’s chemical messengers, and it plays an important role in mood regulation, as well as memory and learning.
Glutamate also supports neuroplasticity, or your brain’s ability to adapt and change with every new experience you have. By increasing neuroplasticity, researchers believe ketamine may help “re-wire” your brain, disrupting problematic or harmful thought patterns and allowing you to form new pathways. Those new pathways allow you to create more positive thoughts, which can help to relieve anxiety symptoms.
Ketamine vs. other medications
Traditional anti-anxiety medications start by boosting other brain chemicals, like serotonin, before targeting glutamate.
What sets ketamine apart is that it immediately activates glutamate. This can translate to faster results, according to Kai Lewis, a licensed marriage and family therapist in private practice. While it can take 2 to 6 weeks for anti-anxiety medications to work, Lewis notes ketamine can help to relieve anxiety in as little as 2 hours.
Bowarshi notes that ketamine has shown benefits for both GAD and social anxiety disorder.
Ketamine treatment types
Ketamine can be taken in multiple ways:
Intravenous (IV) ketamine infusions: A slow, constant IV drip of ketamine is delivered directly into your bloodstream. This can only be done in a hospital or clinic setting.
Intramuscular (IM) shots: Shots are injected into a large muscle, such as your thigh or arm, in a hospital or clinic setting.
Sublingual tablets: This form of ketamine is prescribed for at-home use as a stand-alone treatment or for maintenance in between IV or IM treatments. You put a tablet under your tongue and allow it to dissolve slowly. It takes longer for your body to absorb this type of ketamine, so it’s generally considered to be less effective than other forms. Keep in mind this form of ketamine isn’t FDA-approved, so insurance likely won’t cover the cost.
Nasal spray: Sprovato (esketamine) can only be administered at a hospital or doctor’s office because someone will need to monitor any side effects. You’ll use the spray once or twice weekly for the first 8 weeks, and then only once every week or 2 in the maintenance phase. Sometimes, Spravato is prescribed in combination with traditional anti-anxiety medication.
According to Lewis, IV infusions, intramuscular shots, and nasal sprays are the most common and effective because of how much ketamine can be quickly and easily absorbed into the bloodstream.
How effective is it?
As of now, there’s far more research on the use of ketamine for depression than for anxiety.
That said, a 2021 review concluded that ketamine may be a safe and effective drug for people with anxiety disorders.
Generalized and social anxiety
In another 2022 review, researchers found that single-dose ketamine infusions reduced panic, irritability, and other anxiety symptoms in people with GAD and social anxiety disorder. Higher doses of ketamine were more effective than lower doses, and the anxiety-reducing effects lasted up to 2 weeks.
A small 2017 study found 83% of participants with GAD and social anxiety disorder reported reduced anxiety symptoms within just 1 hour of receiving subcutaneous (under the skin) ketamine treatments.
In another small 2013 study, hospice residents with depression and anxiety took oral ketamine for 28 days. All eight participants who completed the trial reported having reduced anxiety symptoms.
In a small 2017 study of people with social anxiety, participants received IV infusions containing either saline (a placebo) or ketamine. Those who received a ketamine infusion reported much greater improvements in their symptoms compared to those who received the placebo.
However, it’s worth noting the majority of participants could tell when they received the ketamine versus the placebo. This compromised the blinding of the study, meaning participants may have been biased when reporting results.
Other research suggests ketamine may be effective for treating specific phobias.
For example, a small 2021 study showed that after participants received subcutaneous (under the skin) ketamine injections, they reported lower ratings of agoraphobia or fear of certain places or situations where one might be unable to escape.
Obsessive-compulsive disorder (OCD)
OCD is an anxiety disorder marked by uncontrollable and obsessive thoughts and behaviors.
A small 2013 study involved 15 participants with OCD who had almost constant obsessive thoughts.
They received two IV infusions at least a week apart. One infusion contained only saline as a placebo. The other included ketamine.
Participants who received ketamine reported a significant improvement regarding obsessive thoughts following the infusion, compared to no improvement after the placebo infusion.
The effects of the ketamine infusion lasted more than a week for some participants.
Are there any side effects?
Ketamine therapy involves relatively low doses of ketamine, and the side effects are typically minimal and mild.
That said, Julian Lagoy, MD, a psychiatrist with Mindpath Health, says ketamine is not usually recommended for those who are pregnant or breastfeeding or those who have a diagnosis of schizophrenia.
You’ll also want to talk with your healthcare professional about potential risks if you have:
- unmanaged high blood pressure
- a history of substance use disorder (ketamine has the potential to cause physical and psychological dependence)
- a history of psychosis
- heart disease
- a history of increased intracranial pressure
Even if none of those apply to you, Bowasrshi says ketamine can cause the following side effects:
- nausea and/or vomiting
- dissociation, or an out-of-body experience that involves feeling disconnected from your thoughts, identity, and feelings
- increased blood pressure and/or heart rate
- visual changes, like double vision or blurry vision
- perceptual changes, like feeling as if time is slowing down or speeding up
Keep in mind that these side effects are more likely with higher doses of ketamine.
Due to some of these side effects, it’s best to avoid driving or operating heavy machinery until the day after treatment.
In addition, some forms of ketamine come with their own potential risks. For example, Daly notes that complications with IV ketamine can include nerve damage or infection. That’s why finding a reputable clinic with medical professionals on staff is key.
Ketamine can also occasionally contribute to increased anxiety. That’s another reason why it’s important to work with a qualified health professional. They’ll be able to monitor your symptoms and provide support for dealing with any negative side effects.
How to try it
If you’re interested in trying ketamine therapy for anxiety, start by talking with the healthcare professional who manages your current anxiety treatments. They may be able to point you in the direction of a health professional who specializes in ketamine therapy.
You can also look for ketamine therapy on your own, but you’ll want to be extra cautious if you go this route. Freestanding ketamine clinics and online services are popping up all the time, but not all of them perform proper screening or have qualified health professionals on staff.
If you’re prescribed ketamine tablets to take at home, Lewis says it’s important to have a trusted person present in case something goes wrong.
“This can also help with processing any powerful emotional experiences or discomfort,” he adds.
Or, if you receive infusions, injections, or nasal sprays at a hospital or doctor’s office, Lagoy says you’ll need to find a partner, friend, or family member to transport you home.
Finally, be prepared to pay out of pocket. Since ketamine therapy is still a relatively new treatment for anxiety, most insurance companies will not cover it.
The bottom line
There’s limited but growing evidence to support the use of ketamine for anxiety, especially if other treatments aren’t providing results. This approach is still pretty new, however, and may not be right for everyone.
Talk with your primary healthcare professional or psychiatrist, who can evaluate your specific case to figure out whether ketamine might help relieve your anxiety symptoms.
When using ketamine for anxiety, it’s a good idea to educate yourself about the potential side effects and line up a trusted guide to support you through the experience.
Keep in mind that ketamine doesn’t “cure” anxiety, and you’ll likely want to continue working with a therapist to maintain results.
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