Ketamine for Anxiety Disorders


 

While occasional anxiety may be normal, people with anxiety disorders frequently have intense, excessive, and persistent worry and fear about everyday situations that are out of proportion to the actual danger.  Anxiety disorders are the most prevalent psychiatric disorders and according to epidemiological surveys, one third of the population is affected by an anxiety disorder during their lifetime.1  They are associated with a considerable amount of debilitation, high health-care utilization, and an enormous cost to society.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders, such as social anxiety disorder.  Generalized anxiety disorder (GAD) causes excessive fear and anxiety about a wide area of topics including social interactions, school, and work.  Panic disorder causes recurrent intense panic attacks that can occur unexpectedly or be triggered by an object or situation.  Social anxiety disorder (SAD) causes a general intense fear of social or performance situations.  One-third to one-half of patients with SAD will not respond to traditional pharmacotherapy, such as selective serotonin reuptake inhibitors.2

Converging lines of evidence from clinical rodent studies, neuroimaging, and pharmacologic studies have established a strong link between glutamate regulation and anxiety.2  Based on the improvement in symptoms of patients with treatment-resistant depression, a double-blind, placebo-controlled study was undertaken which concluded that intravenous ketamine was just as effective in both anxious and nonanxious depression, which is in contrast to traditional antidepressants such as citalopram.3  In addition to demonstrated effectiveness in depression, obsessive-compulsive disorder, and post-traumatic stress disorder, an ascending single dose study established that intravenous ketamine may have broad efficacy in refractory anxiety disorders.4  Their followup study established the safety and efficacy of maintenance ketamine for anxiety over a 3 month period.5 

While these treatments are revolutionary, it is important to understand that not everyone responds to intravenous ketamine for anxiety disorders.  While some experience immediate relief, many notice improvement after the third treatment.  If there is an appropriate response, we will tailor a maintenance schedule.  We recognize that intravenous ketamine represents only one part of the multi-modal therapy for psychiatric disorders.  We will integrate care with your psychiatrist and/or primary care provider to promote the best possible results.

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Ptsd

  

 anxiety

 

  1. Bandelow B, Michaelis S. Epidemiology of Anxiety Disorders in the 21st Century. Dialogues Clin Neurosci. 2015 Sep; 17(3): 327–335.

  2. Taylor J, Landeros-Weisenberger A, et al. Ketamine for Social Anxiety Disorder; A Randomized, Placebo-Controlled Crossover Trial. Neuropsychopharmacology. 2018; 43: 325–333.
  3. Salloum N, Fava M, et al.  Efficacy of Intravenous Ketamine Treatment in Anxious Versus Nonanxious Unipolar Treatment-Resistant Depression. Depress Anxiety. 2019; 36: 235-243.
  4. Glue P, Medlicott N, et al. Ketamine’s Dose-Related Effects on Anxiety Symptoms in Patients with Treatment Refractory Anxiety Disorders. J Psychopharmacol. 2017 Oct; 21(10): 1302-1305.
  5. Glue P, Neehoff S, et al. Safety and Efficacy of Maintenance Ketamine Treatment in Patients with Treatment-Refractory Generalized Anxiety and Social Anxiety Disorders. J Psychopharmacol. 2018; 32: 269881118762073.