Low Dose Ketamine Therapy and Anxiety Disorders
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Over the last two decades a surge of scientific research on low dose ketamine and ketamine assisted therapy (KAP) has shown promise for the treatment of a host of mental health concerns including treatment-resistant depression, OCD, and PTSD. I wanted to take a few minutes to explore the research specific to ketamine therapy for the treatment of anxiety. Although the body of research for generalized anxiety disorder and other anxiety mental health diagnoses is smaller than for depression, the results are encouraging and the risks generally low.
Here’s what some of the studies specific to patients experiencing anxiety state:
- A small study of patients with GAD were treated with either ketamine or midazolam. There were changes seen on improved fear questionnaire scores as well as changes in brain (theta) waves what were comparable to conventional medications used for anxiety.
- Another study compared patients with refractory generalized anxiety disorder (GAD) and social anxiety disorder (SAD) who reported reduced anxiety 1 hour after dosing, although these results were from intravenous infusions (not oral or intranasal ketamine dosing).
- This study was continued and the impact of maintenance ketamine therapy was measured for patients with generalized anxiety disorder (GAD) and social anxiety disorder (SAD). The study concluded that 18 of 20 patients continued to experience ongoing improvements in their GAD scores with intermittent maintenance ketamine dosing.
- In anxious depression, a study was conducted that both anxious and non-anxious patients with bipolar depression had significant antidepressant response to ketamine therapy. This is important as it has been shown that patients who have bipolar depression with anxiety tend to have poor responses to conventional medical treatments. Further study for this patient population was recommended.
As with many available treatments for anxiety and depression, risk/benefit evaluation needs to be individualized. I often see patients who describe their experiences with a one-size-fits-all approach to mental health and the sense of pain and hopelessness they feel when they “run out of options.”
As a Naturopathic Doctor and Acupuncturist, I live in the world of alternatives. I am so grateful that I have been trained to understand and engage in the western medical model, but really where naturopathic medicine shines is in providing alternative treatment options to typical standard of care medicine. We use herbs, needles, hydrotherapy, touch therapy, counseling, nutrition, medications, and exercise to provide a multitude of alternatives for every type of health concern under the sun, including anxiety, depression, PTSD, and many other mental health concerns.
When I first learned about ketamine assisted therapy (KAP), I was intrigued by this amazingly versatile molecule. It works on both the physical and psychological levels to help patients who are profoundly depressed, anxious or both. Low to moderate doses of ketamine can be used in an outpatient office setting to quickly and profoundly improve stubborn depression, anxiety, OCD, etc.
We know that approximately 30-40% of patients with anxiety and/or depression have a poor response to serotonin reuptake inhibitors (SSRIs) and other medications in similar classes. Alternative classes of treatments are available including the older MAO inhibitors and newer medications which are often in the antipsychotic classes of medical treatments. Many patients experience that these medications are ineffective or not well tolerated due to significant side effects.
Ketamine is an emerging treatment option and more research is absolutely necessary to further delineate which patients/treatment groups will be most beneficially impacted by this therapy. Research is also needed to assess the effectiveness of low to moderate ketamine dosing, and alternatives to IV or IM ketamine.
However, low to moderate dose ketamine and ketamine assisted therapy is legal, available, and low risk for many patients. In my practice, I provide a medical evaluation, risk assessment, and informed consent regarding ketamine therapy. I have witnessed the truly life changing, life-saving transformative power of this medicine and hope that more information, research, and education becomes available to both patients and providers for this encouraging alternative medical therapy.
References:
Ionescu DF, Luckenbaugh DA, Niciu MJ, Richards EM, Zarate CA. A single infusion of ketamine improves depression scores in patients with anxious bipolar depression. Bipolar Disord. 2014;17(4):438-443.
Glue P, Medlicott NJ, Harland S, et al. Ketamine’s dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders. J Psychopharmacol. 2017;31(10):1302-1305.
Glue P, Neehoff SM, Medlicott NJ, Gray A, Kibby G, McNaughton N. Safety and efficacy of maintenance ketamine treatment in patients with treatment-refractory generalised anxiety and social anxiety disorders. J Psychopharmacol. 2018;32(6):663-667.