If you’re interested in trying ketamine therapy for anxiety disorders — you’re in the right place.
This in-depth article covers everything you need to know about the benefits of ketamine for anxiety disorders. Learn how it works, is it safe, what are the infusions like, legality, and more.
In this article, you’ll learn:
- What is ketamine?
- What is an anxiety disorder?
- How does ketamine treat anxiety disorders?
- What does the research say?
- What’s the process of getting ketamine therapy for anxiety disorders?
- What are ketamine infusions like?
- How safe are maintenance ketamine treatments for anxiety?
- How much does it cost?
- Is it legal?
Are you dealing with an anxiety disorder that doesn’t respond to treatment?
Ketamine might be your answer.
A growing body of scientific evidence highlights the potential role of ketamine — a novel experimental drug — in the treatment of treatment-resistant anxiety disorders.
Ketamine is a fast-acting medicine that often produces mood changes within hours. This means that if ketamine therapy works for you, you can have your life back in an instant. Read on to find out more about this novel approach to treating severe anxiety disorders.
What Is Ketamine?
Ketamine is an FDA-approved anesthetic used to put you to sleep before surgery. This drug prevents pain and discomfort during certain medical tests and procedures.
Its dissociative properties are helpful during medical emergencies and traumatic injuries. Ketamine causes short term memory loss and relaxes the patient. If a patient comes in with a dislocated shoulder, doctors give him ketamine. That way, he won’t remember when they fix his shoulder.
As a dissociative anesthetic — even in the lowest doses — ketamine may cause hallucinations or a “mind and body separation.” Due to these effects, people use it recreationally as a “party” drug known as Special K.
In the past two decades, ketamine became a promising novel drug for mood disorders like treatment-resistant depression, anxiety, and post-traumatic stress disorder.
What is an anxiety disorder?
An anxiety disorder is a mood disorder characterized by significant feelings of anxiety, worrying, and fear. According to the Anxiety and Depression Association of America, anxiety disorders impact almost 1 in 5 adults in the U.S.
Anxious feelings like temporary worry or fear are an expected part of life. You may feel anxious before making an important decision or when facing a problem at work. But, having an anxiety disorder is more than that.
A person with an anxiety disorder feels constant and excessive worry. It’s intense and can interfere with daily activities, job performance, school, and relationships. The most common signs and symptoms of an anxiety disorder are:
- Excessive worrying
- Difficulty concentrating
- Tense muscles
- Trouble falling or staying asleep
- Panic attacks
- Avoiding social situations
- Irrational fears
Major types of anxiety disorders
The main types of anxiety disorders are:
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Social Phobia (Social Anxiety Disorder)
- Selective mutism
- Separation anxiety disorder
Obsessive-compulsive disorders and trauma and stressor-related disorders (like PTSD) are now separate categories in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These two categories were part of the anxiety disorders group in the past.
How Does Ketamine Treat Anxiety Disorders?
Researchers are investigating the effects of this novel drug on the brain. Because of the unknowns, medical professionals recommend ketamine therapy only to people with treatment-resistant anxiety disorder. Individuals diagnosed with treatment-resistant anxiety have gone through standard anxiety disorder treatments, but :
- The treatments were totally ineffective: the patient didn’t respond to the treatment at all.
- The treatments were modestly effective: the patient responded to treatment, but the condition didn’t achieve remission.
The treatment options for patients diagnosed with treatment-resistant depression are limited to:
- Anti-anxiety medications (benzodiazepines),
- Antidepressants (SSRIs and SNRIs),
- Psychotherapy (cognitive-behavioral therapy), and
- Beta-blockers (often used to treat high blood pressure).
Antidepressants increase the serotonin levels in the brain, while benzodiazepines increase the effect of a brain chemical called GABA. This chemical (GABA) reduces brain activity in the areas of the brain responsible for rational thought.
Around 20-30 percent of people diagnosed with an anxiety disorder don’t respond to these traditional treatments. In addition, an antidepressant and benzodiazepine treatment may take 6 to 12 weeks to work. That’s a long time for a person with a severe anxiety disorder to start noticing improvements, which drives the search for other molecular targets.
This is when ketamine enters the picture. Unlike these drugs, ketamine is considered a “dirty drug.” That means it may bind to different molecular targets or receptors in the body. Its versatility explains its wide range of effects on various conditions. Most importantly, ketamine works faster than traditional medication.
Researchers believe that ketamine stimulates the regrowth of synapses (connection between neurons) and rewires the brain. Ketamine affects the serotonin neurotransmitter (the one targeted by antidepressants). But, in general, it acts on the glutamate system. Glutamate is the most common chemical messenger in the brain. It plays a major role in learning and memory.
A growing body of evidence suggests the involvement of glutamate in anxiety disorders. One study showed that adolescent patients diagnosed with Generalized Anxiety Disorder (GDA) showed a positive correlation between glutamate-related activity and severity in anxiety symptoms. Glutamate may also mediate the brain’s response to stress and formation of traumatic memories .
More research is needed to determine how ketamine affects the brain and produces anti-anxiety effects.
Effectiveness of Ketamine Infusion Therapy For Various Anxiety Disorders
Studies on ketamine and anxiety disorders show its effectiveness with general anxiety disorder, social anxiety disorder, and anxious depression.
Social anxiety disorder
One double-blind, randomized trial published in Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology investigated the effects of this drug on social anxiety disorder. Eighteen adults diagnosed with social anxiety disorder received 0.5mg/kg intravenous ketamine (and placebo) in a random order for 28 days .
Researchers found that ketamine resulted in a significant reduction in anxiety compared to placebo within the first two weeks following infusion. They measured the progress on the Liebowitz Social Anxiety Scale (LSAS).
Generalized anxiety disorder
Researchers evaluated the efficacy and safety of ketamine in 12 patients with treatment-resistant generalized anxiety disorder and/or social anxiety disorder who were not currently depressed. They used an ascending single-dose study design (0.25, 0.5, 1mg/kg) at weekly intervals. The study revealed that within 1 hour of dosing, patients reported reduced anxiety, which persisted for up to seven days .
The patients tolerated the drug well. Researchers concluded that ketamine might be a potential therapeutic alternative for these patients. They also point out the potential efficiency of this drug in disorders characterized by negative emotional states.
Around 67% of patients with a depressive disorder also suffer from anxiety. The presence of two conditions at the same time is known as comorbidity and makes the disorder particularly difficult to treat .
A study performed by the researchers at the Massachusetts General Hospital investigated the effects of ketamine on 99 patients with treatment-resistant depression, out of which 45 had anxious depression. The patients either received ketamine at one of the four doses (0.1, 0.2, 0.5 or 1.0 mg/kg), or midazolam at a dose of 0.045 mg/kg .
The study revealed that ketamine is equally effective in treatment-resistant depression with or without anxiety — when measured on the first and third day after infusion. On day three, the non-anxious patients responded significantly better at the lowest dose (0.1 mg/kg) than the anxious group.
However, within 40 minutes of receiving the infusion, the patients with anxious depression experienced fewer “dissociative” symptoms — memory loss and a sense of detachment — than participants without anxious depression.
The correlation between dosage and its anti-anxiety effects
At what dose do patients with an anxiety disorder respond to ketamine?
A study published in the Journal of Psychopharmacology looked at the dose-related effects of this drug on anxiety symptoms in patients with treatment-refractory anxiety disorders. Researchers noted a dose-response profile of the drug on:
- Anxiolytic effects (anti-anxiety effects)
- Dissociative side effects
- Changes in blood pressure and heart rate
They noticed minor changes at 0.25 mg/kg, and progressively greater and more durable changes at the higher doses. Ten out of 12 patients responded to ketamine dose of 0.5 – 1mg/kg .
What’s the process of getting ketamine therapy for anxiety?
Let’s walk you through the ketamine infusion process from beginning to end.
Step 1: Initial Assessment
Before starting your therapy, the team in charge of the clinic you choose should schedule an initial assessment. This assessment aims to get a comprehensive mental health screening and a general physical and medical exam. Make sure the clinic you choose is reliable, equipped with a psychiatry team, a certified nurse anesthetist, or an anesthesiologist.
For additional safety, the clinic should ask you to do a urine test to rule out indications of illicit drug abuse. They should ask you for proof of valid prescription for controlled medication.
This process may seem thorough and burdensome, but it’s of utmost importance that you follow through and keep it honest with the doctors.
Step 2: Infusion Session
On the day of the infusion session, you’ll meet the anesthesiologist, who will walk you through the treatment process. Then, it’s a relaxing time! They will seat you on a comfortable lounge chair, give you headphones to listen to music, or turn on the TV.
One infusion secession typically lasts from 40-45 minutes, some may last to an hour. An anesthesia professional will closely monitor you and check if you’re feeling anxious or restless.
Step 3: After Session
The medical staff should give you another assessment after the treatment. They should provide ongoing support and discuss your symptoms in the following days.
Important: Invite a partner, family member, or a friend to accompany you. Driving is not permitted within the first couple of hours after the session.
What do ketamine infusions feel like?
It depends on the person. During the ketamine infusion, you may:
- Feel like you’ve taken a few glasses of wine
- Experience stronger “dissociative” feeling, or an out-of-body experience
- Hallucinate intense atypical colors and visuals
- Stay clear-headed and grounded, feeling an increased appreciation for life and music
- Have a groundbreaking realization that anxiety doesn’t define you
- Experience numbness and a tingling sensation in the entire body
- Have control over your thoughts and know that you are safe
You may start feeling anxious. If this is the case, communicate it with the doctor. They will adjust your dose and monitor you further. If the anxiety becomes severe or unpleasant, tell your caregivers.
After the ketamine infusion, if you respond to the treatment well, you should feel the effects of the drug almost immediately.
A few hours after treatment or by the next morning, you will feel an overwhelming sense of relief.
How safe is ketamine for anxiety?
Ketamine is a pretty safe drug if used in the correct way and under medical supervision. Some patients continue treatment with standard antidepressants or mood stabilizers during ketamine therapy.
What about benzodiazepines (anti-anxiety medications)?
Some medications for mood disorders affect the same pathways in the brain as ketamine. This means that they may affect the efficacy of ketamine. Benzodiazepines like Xanax, Ativan, and Kloponin, are a common anxiety therapy.
Using benzos during a ketamine treatment might reduce the effectiveness of this drug. This means a longer time to see improvement in mood and feeling better. One study found that “benzodiazepines attenuate ketamine’s antidepressant effect in patients with major depressive disorder .”
As with any therapy, ketamine may cause some minor side-effects. If you experience serious side-effects within 24 hours after therapy, tell your caregivers immediately.
Serious side-effects include:
- Severe confusion
- Unusual thoughts
- Extreme fear
- Painful or difficult urination
Most common side-effects:
- Dream-like feeling
- Loss of appetite
- Blurred vision
- Double vision
- Sleep problems (insomnia)
Risks of ketamine infusion
You should not undergo ketamine therapy if you have untreated or uncontrolled high blood pressure. This drug increases blood pressure and heart rate in some people, so take extra precautions if you have any cardiovascular problems.
If you’ve had any issues with psychosis in the past, this drug might make it come back. If the psychosis is undiagnosed, it might make it worse.
In high doses, ketamine may cause severe urinary problems that may lead to bladder removal.
Never take alcohol, opioids, or other substances that may depress breathing during treatment.
Long term, frequent use may cause cognitive impairment and memory problems. Occasional use (once or twice a month) is fine .
Why do some patients experience anxiety during ketamine treatment for depression?
One study demonstrated that patients with major depressive disorder who respond negatively to the treatment experience higher anxiety during ketamine infusions. In the study, 31 patients received three ketamine infusions per week. The dosage was the standard 0.5mg per kg and the patients received this therapy for two consecutive weeks.
“After six infusions, 17 of 31 patients (55%) showed a response to ketamine treatment, while 14 patients (45%) had no response. Anxiety-related experiences induced by ketamine were significantly higher in non-responders .”
Maintenance ketamine treatments for treatment-resistant anxiety?
The main unresolved question of ketamine therapy for mood disorders is: how to maintain improvement in symptoms?
Researchers don’t know how long-term use of this drug affects the brain. So, most clinics schedule maintenance treatments between longer intervals while considering patients’ needs.
The first few ketamine treatments are stabilization treatments. Most patients report recurrence of anxiety symptoms within a week after dosage. So, to keep the symptoms at bay, doctors recommended maintenance treatments.
One 2018 study published in the Journal of Psychopharmacology evaluated the safety and efficacy of maintenance ketamine treatment in patients with treatment-resistant generalized anxiety (GAD) and social anxiety disorders (SAD) .
Twenty (20) patients received one or two weekly ketamine doses (1mg/kg injected subcutaneously or under the skin) for three months. Fifteen patients (75%) met criteria for generalized anxiety disorder and 18 (90%) for social anxiety disorder.
“Ketamine was administered as a subcutaneous injection in the upper arm, using each individual patient’s highest tolerated dose. Dosing frequency was based on duration of response to ketamine: those who remained free of anxiety for 5 days or longer were dosed once weekly, whereas those with shorter duration of response could be dosed twice weekly.”
- Researchers concluded that maintenance treatment of 1-2x weekly dosing (1mg/kg) up to 3 months is safe and well-tolerated.
- Eighteen patients completed 3 months of maintenance therapy, and all of them reported improvements in social and work environment.
- Twenty-five (25) percent of patients remained anxiety free after the treatment.
- Patients tolerated the treatment well, making improvement in work and social functioning.
- Researchers noted the same side effect as during the first treatments, including nausea, dizziness, and blurred vision.
The most striking benefit of ketamine maintenance treatment was the improvement in work and social functioning.
Ketamine treatments enabled patients to make substantial changes to their lives. Some of them got jobs or boosted work performance. Others went back to school and experienced significantly better social lives. All of these changes seemed impossible before the treatments.
Anecdotal evidence shows that people who have been taking ketamine therapy for mood disorders for over a decade — typically via a muscle injection — haven’t seen major side-effects. They do feel dependent on it, just like when taking anti-anxiety medication or antidepressants. But, aside from that, individuals who respond to ketamine therapy continue to roll safely with it.
Cost of ketamine therapy for severe anxiety
What is the out of pocket cost for one treatment of ketamine therapy for severe anxiety?
It depends on the clinic. The lowest price most clinics offer to administer one ketamine treatment is $350 per infusion. At that cost, they typically include:
- The visit (a private or shared room)
- The infusion (plus supplemental medications you may need during treatment)
- The monitoring (an RN nurse or paramedic to monitor vital signs).
Before getting an infusion, you need to go through an evaluation that can cost anything from $150-$250.
If you have insurance that the clinic accepts, you won’t have to pay for the evaluation visit, the main visit to get the drug, the infusion, and monitoring. The only thing you have to pay for, in this case, is the ketamine medication. Most clinics take insurance, but insurance doesn’t pay for the drug. The reason for that is that ketamine is still an off-label medication for anxiety.
High-end clinics can charge as much as $800 per infusion. For mood disorders like severe anxiety, you’ll need a series of 6 infusions over a 2-3 week period.
Can I just have one ketamine treatment for severe anxiety? You can, but it might not be enough. Research shows that if the patient doesn’t respond to the first two ketamine treatments, then this medication might not be right for them. So, it’s better to have 2-3 treatments to see if this therapy will help your anxiety.
Is it legal?
Ketamine is a Schedule III drug under the Controlled Substance Act, meaning it has a moderate to low abuse potential. Its current accepted medical use is for induction and maintenance of anesthesia. According to this classification, ketamine is safer than cannabis, which is a Schedule I controlled substance.
This means that your caregiver cannot prescribe ketamine as an anxiety medication. But, they can recommend it off label. This is the premise on which ketamine clinics operate lawfully. Ketamine infusion therapy is an off-label use for mood disorders, like treatment-resistant anxiety disorder and chronic pain.
Off-label use of a drug simply means that a drug is used for another disease in another form than the one approved by the FDA. For example, a drug is:
- Used for a disease or medical condition that it is not approved to treat, such as when a chemotherapy is approved to treat one type of cancer, but healthcare providers use it to treat a different type of cancer.
- Given in a different way, such as when a drug is approved as a capsule, but it is given instead in an oral solution.
- Given in a different dose, such as when a drug is approved at a dose of one tablet every day, but a patient is told by their healthcare provider to take two tablets every day.
It’s important to know that ketamine clinics must have a DEA license and register the medical professionals that administer, store, or distribute the drug.
Clinics choose how to operate their business. Most rely on clinical research and guidelines like the consensus statement in Regional Anesthesia & Pain Medicine and comprehensive checklists by the American Association of Nurse Anesthetists.
Find a legal ketamine clinic nearby:
- District of Columbia
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
Ketamine is a safe and effective treatment for people diagnosed with an anxiety disorder who don’t respond to traditional therapy. Studies show promising results with an array of anxiety disorders, like social anxiety disorder (SAD), generalized anxiety disorder (GAD), and anxious depression. This novel drug acts faster than antidepressants and benzodiazepines and can have a calming effect on the nervous system.
Ketamine therapy for anxiety disorders FAQs
Researchers believe ketamine affects glutamate, the body’s most abundant excitatory neurotransmitter.
Ketamine is still a novel, experimental drug for mood disorders like anxiety and depression. Right now, there is very little data on its long-term use.
Yes. This drug is a dissociative, it produces a mind-body separation, which is why it is often used recreationally.
No. It may mildly stimulate the opioid receptor, but it’s not an opioid.
If you receive ketamine from a healthcare professional in a medical setting, you won’t overdose. If you take this drug in high doses or together with another medicine, you may overdose.