Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: a review of the literature

Summary & key facts

This paper reviews published reports and trials that looked at ketamine as a treatment for anxiety and related disorders. The authors found early evidence that ketamine can reduce anxiety symptoms quickly and that many patients tolerate it without major short-term side effects. However, the studies are still limited, and the long-term safety and effects of repeated use are not known, so more research is needed before ketamine can be recommended as a routine treatment.

Key facts:

• The authors reviewed case reports (stories about single patients), case series (small groups of patients), and controlled trials (studies that compare treatments) to see what evidence exists for ketamine in anxiety disorders.
• There is limited but growing evidence that ketamine can help reduce symptoms of anxiety and anxiety-spectrum conditions.
• In the studies reviewed, ketamine often worked quickly and produced a high rate of symptom improvement compared with what researchers usually expect from standard treatments.
• Patients in the reviewed reports generally tolerated ketamine and experienced only a limited set of short-term side effects.
• The effects of long-term or repeated use of ketamine for anxiety are unknown, and the authors say more research is needed to understand safety and tolerability over time.
• Ketamine has been used especially for people whose anxiety or depression did not get better with other treatments, but evidence for this use is still preliminary.

Abstract

Anxiety disorders are among the most prevalent psychiatric conditions. Despite many proven pharmacological and non-pharmacological treatments available, high rates of partial response and low rates of long-term remission remain. Ketamine has been receiving increasing attention as an interventional treatment modality in psychiatry, especially among refractory conditions, including major depressive disorder. There is limited yet growing evidence to support the use of ketamine in anxiety disorders. In this review of the literature, we present case reports, case series, and controlled trials demonstrating proof-of-concept for its potential role in the treatment of anxiety and anxiety spectrum disorders. Its unique mechanism of action, rapid onset, and high rate of response have driven its use in clinical practice. Ketamine is generally well tolerated by patients and has a limited side effect profile; however, the effects of long-term use are unknown. While there is a growing body of research and increasing clinical experience to suggest ketamine may have clinical applications in the treatment of refractory anxiety disorders, further research to determine long-term safety and tolerability is indicated.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Adverse effect Anxiety Astrobiology Clinical psychology Clinical trial Internal medicine Ketamine Medicine Physics Psychiatry Psychology Refractory (planetary science) Tolerability

Substances

Ketamine

Conditions & symptoms

Anxiety Anxiety or worry