Ketamine therapy is a new approach to treating anxiety, offering potentially fast-acting relief for those who haven’t found help with traditional methods.

Ketamine was originally developed in the 1950s 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 that 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.

According to Khaled Bowarshi, MD, a psychiatrist at Florida TMS Clinic, ketamine appears to quickly boost the activity of glutamate, a chemical in the brain that helps with mood, memory, and learning.

While researchers are still figuring out exactly how this works to reduce anxiety, some studies suggest that long-term stress can throw off the balance of glutamate and make it harder for the brain to adapt and grow.

Ketamine may help, according to Dr. Bowarshi, by restoring that balance and supporting the brain’s ability to form new connections.

This process, called neuroplasticity, could make it easier to break out of negative thought patterns and build healthier ones, which may lead to relief from anxiety symptoms.¹

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. For instance, while it can take 2 to 6 weeks for anti-anxiety medications to work, ketamine can help to relieve anxiety in as little as 3 hours.

Bowarshi notes that ketamine has also shown benefits for both GAD and social anxiety disorder.

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 (lozenges): 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.

IV infusions and nasal sprays are the most commonly used methods for administering ketamine for treatment-resistant depression in clinical settings. However, there are clinics using ketamine lozenges, also known as sublingual ketamine or ketamine troches, for off-label treatment of anxiety.

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.

Phobias

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.

Additionally, a 2021 systematic review found that ketamine can quickly reduce anxiety symptoms in people with social anxiety disorder and generalized anxiety disorder, especially at higher doses (1 mg/kg).

The review found:

  • effects often last up to 7 days after a single dose
  • repeated treatments can maintain relief for months
  • symptoms may return within two weeks after stopping treatment

Obsessive-compulsive disorder (OCD)

OCD is an anxiety disorder marked by uncontrollable and obsessive thoughts and behaviors.

The same 2021 systematic review found that ketamine can quickly reduce symptoms in people with treatment-resistant OCD.

  • A single IV dose led to lower OCD symptoms up to 7 days after treatment.
  • About half of patients experienced a 35% or more symptom reduction compared to none on placebo.
  • Benefits tend to be temporary, lasting only a few hours in some cases.

It’s important to note, however, that the trials being referenced contained small sample sizes.

The verdict

“Ketamine may provide a unique alternative treatment option for both immediate relief and maintenance treatment,” says Bowarshi.

However, Kate Daly MD, the Medical Director of All Points North, notes that ketamine is most effective for anxiety when it’s paired with therapy. Therapy can help with addressing the underlying causes of anxiety, while ketamine simply helps to tone down the mental and physical symptoms.

Not sure where to start? Our guide to finding the right therapist for you can help.

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:

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 managing any negative side effects.

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.

What to look for in a clinic

When choosing a ketamine clinic, the American Society of Ketamine Physicians, Psychotherapists, and Practitioners recommend considering:

  • Additional mental health services: Ketamine therapy tends to work best as part of a larger treatment plan. Look for clinics that offer additional mental health support, like group therapy or medication management.
  • Physicians on staff: The clinic should have board certified physicians on staff with experience in fields related to mental health. Use your state’s medical board website to look them up and ensure they’re licensed.
  • Clinic history: If possible, look for clinics that have been open for at least 2 years. Be sure to check for any reviews online.
  • Medical claims: While ketamine therapy shows promise as a potential treatment option for several mental health conditions, it’s not an overnight “cure.” Avoid clinics that make over-the-top claims about ketamine therapy.
  • Screening: Reputable ketamine clinics will have you go through one or two consultations with a healthcare professional to ensure that ketamine therapy is right (and safe) for you. During this consultation, you’ll talk with them about your symptoms, treatment goals, and medical history.

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, and is, therefore, considered an “off-label” treatment, most insurance companies will not cover it.

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.

Rebecca Strong is a Boston-based freelance writer covering health and wellness, fitness, food, lifestyle, and beauty. Her work has also appeared in Insider, Bustle, StyleCaster, Eat This Not That, AskMen, and Elite Daily.