Everything You Need to Know About Ketamine for Anxiety

Ketamine Therapy for Anxiety

In Greenville, SC and throughout the United States, anxiety disorders are among the most prevalent mental health disorders. At MindWell in Greenville we’ve made a calm healing space to treat patients with anxiety using ketamine in a similar way that it is used for depression and pain.

We understand that anxiety disorders can be incapacitating and affect people of all ages. Anxiety disorders can manifest as phobias, panic disorder, post-traumatic stress disorder, the severity of symptoms range from mild to severe. 

Thankfully, anxiety can be managed by proper treatment. Lifestyle changes can have an important role in minimizing symptoms; avoiding triggering environments, getting adequate sleep, and even exercising are known to help with the symptoms of anxiety disorders. In many instances, though, lifestyle changes are not enough, and treatment may require a combination of psychotherapy and medicine. 

As time goes on, therapies for anxiety and other mental health problems continue to advance. New drugs are developed and existing drugs find new applications.  A good illustration of this is ketamine therapy: a drug that has been safely used for decades, but only recently has been applied to mental health conditions.

Table of Contents

• What is ketamine therapy?

  • Anesthetic developed in the 1960’s

  • Safe, effective and used millions of times

  • Recently found to have mental health applications

  • Research ongoing

• How does ketamine work?

  • NMDA antagonist

  • Glutamate system

  • Neuroplasticity - “re-wire” the brain

• Types of Ketamine therapy

  • IV - most common route

  • Intramuscular - difficult to judge dose

  • Sublingual - under the tongue, questionable bioavailability

  • Intranasal - Spravato, esketamine - covered by most insurance

• What are the side effects of ketamine therapy?

  • Typically rare and mild

  • Sedation

  • Dissociation

  • Transient increased blood pressure

  • Rarely bladder issues

• How is ketamine different from other treatments?

  • Glutamate vs Serotonin

  • Fewer side effects

  • More effective

  • Must be given in clinic under supervision

• How to try ketamine therapy?

• Conclusions

What is Ketamine Therapy?

Because of its analgesic and sedative properties, ketamine was first developed as a general anesthetic in the 1960s and was approved and came into common use in the 1970s.   Ketamine has been used safely as an anesthetic millions of times around the world since then.

However, in recent years, scientists have begun to explore ketamine's therapeutic potential in the treatment of a variety of mental health disorders, including anxiety, depression, and post-traumatic stress disorder (PTSD).

Although several drugs exist to alleviate the symptoms of anxiety, studies show that around half of those with a Generalized Anxiety Disorder (GAD) who seek therapy ultimately fail to find relief.  This proves that there is a great need for more effective therapies for anxiety.  That's where ketamine comes in.  Ongoing research shows that ketamine is a very effective option for treating resistant cases of anxiety.

Since ketamine was originally approved as an anesthetic and is now off patent, it is unlikely that any company will ever choose to undergo the expensive process that it takes to get a new FDA indication for a medicine. Thankfully, ketamine may still be prescribed "off-label" by physicians for the treatment of anxiety disorders. This is referred to as ketamine therapy.  The fact that it's "off label" doesn't mean that it's not effective or safe.  Actually evidence continues to mount supporting ketamine's use for mental health treatments.

How Does Ketamine Therapy Work?

Ketamine is an NMDA antagonist and is thought to produce its effects by rapidly elevating glutamate levels and altering glutamate activity in the brain.  It's a complicated process and there is still much to be learned about how ketamine works in the brain.

Glutamate is a chemical messenger in the brain, and it plays a significant part in the regulation of mood, in addition to playing a function in memory and learning.

Glutamate is also believed to affect neuroplasticity in the brain, which refers to the capacity of your brain to adapt and change in response to new experiences. 

Researchers believe that ketamine's ability to increase neuroplasticity may assist in "re-wire" of the brain. This would include breaking problematic or detrimental thought processes and allowing for the formation of new pathways. 

These new neural connections enable you to think more positively, which, in turn, may help to alleviate some of the symptoms of anxiety.

Types of Ketamine Therapy

There are a few different methods to administer ketamine for therapy.  Here in Greenville, we use intravenous (IV) ketamine and intranasal esketamine (Spravato). The IV Ketamine infusion schedule progresses like this.

IV Ketamine 

During an IV ketamine infusion, small amounts of the drug are released into the patient's circulation in the form of a steady drip. This is something that can only be done in a clinical or hospital context.  This is the most common and most controlled way to administer ketamine.

Intramuscular Shots

Shots are administered intramuscularly (IM), which means they are injected into a big muscle, such as your thigh or arm, at a medical facility or clinic.  We don't use this method at MindWell because it's hard to know exactly how much ketamine is absorbed into the system. 

Sublingual Tablets

Under-the-tongue tablets are a form of ketamine that is often given as a prescription to patients for use at home either as a stand-alone therapy or for maintenance in between IV or IM treatments.  We are considering this use at MindWell in Greenville, but want to see more research emerge first.  Before we feel comfortable prescribing ketamine in this way, we want to know that the oral dose is consistent, safe, and effective.

When patients use it this way, a tablet is placed under the tongue, and the dissolution process takes place at its own pace. Because it takes the body longer to absorb this kind of ketamine, it is often regarded as having a lower potency than that of other varieties.  Keep in mind this type is not FDA approved and insurance is less likely to pay for it.

Spravato Nasal Spray

Recently, Jansen pharmaceuticals received FDA approval for its intranasal drug called esketamine (Spravato). Esketamine is the s-enantiomer of ketamine and one of the two molecules that make up ketamine. As part of the approval process, esketamine nasal spray can only be given in a medical setting, such as a hospital or a doctor's office, the patients must be monitored for at least two hours after the administration of Spravato, and it can only be prescribed for treatment-resistant depression or depression with suicidality. Spravato is covered by most insurance and we are in-network with many insurance providers here in Greenville.

During the first eight weeks, you will use the spray once or twice every week. After that, during the maintenance phase, the nasal spray will only be needed weekly or every other week. It is possible to get a prescription for Spravato in addition to more conventional forms of treatment for anxiety, but only if you have treatment-resistant depression in addition to anxiety.

The most common and effective way to administer ketamine is by IV infusion since this route allows the most control over how much and how quickly the ketamine is absorbed into circulation.

What are the Side Effects of Ketamine Therapy?

Thankfully, the side effects of ketamine are typically few and very mild due to the very low doses of ketamine that are used in ketamine therapy.  These include, but are not limited to a dissociative out-of-body feeling, increased blood pressure, transient sedation, and very rarely, bladder issues.  It should be noted that ketamine does not appear to show any signs of addiction or dependence, but it could rarely occur. Ketamine is not often suggested for individuals who are either pregnant or nursing, as well as for those who have been diagnosed with schizophrenia. You should also discuss the possible risks with your doctor if you have any of the following conditions or symptoms:

• Unmanageable high blood pressure

• A previous diagnosis of schizophrenia or cardiac illness

• A previous history of elevated pressure inside the skull

• A history of psychosis or psychotic episodes

Ketamine might induce the following negative effects, even if none of the aforementioned apply to you:

• A feeling of nausea, vomiting, and/or lightheadedness

• A dissociative episode, often known as an out-of-body experience, is characterized by a sense of disconnection from one's thoughts, emotions, and identity.  Many people find this experience to be calming and pleasant. 

• Sleepiness

• Increased blood pressure or heart rate

• Changes in vision, such as double vision or hazy vision 

• Changes in perception, such as the sensation that time is either slowing down or speeding up 

Keep in mind that higher doses of ketamine are associated with an increased risk of experiencing these adverse effects.  In Greenville, we utilize much lower doses than would be used for anesthesia. Because of the potential for any of these adverse effects, we advise our patients to wait until the day after treatment to drive or use any heavy equipment.

For these reasons, it's essential that ketamine therapy only takes place under the care of a trained team, primarily because they will be able to monitor your symptoms and provide assistance with any adverse effects that may arise.

How is Ketamine Therapy Different from Other Antidepressants?

Ketamine operates in a manner that is distinct from those of other antidepressants now available for medical use. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are the two types of antidepressants that are prescribed the most frequently. 

Both of these groups of drugs act on a neurotransmitter called serotonin, which is found in the brain. Serotonin is an essential chemical messenger for the brain and plays a role in your mood as well as your levels of energy and motivation.

The neurotransmitter serotonin is suspected to play a role in mood disorders such as depression. Low levels or dysfunction in the action of this essential chemical have been linked to signs of depression such as low mood, lack of interest in activities, and other frequent symptoms of the disorder. But as with many diseases, mental health disorders are complex and seem to be related to more than just serotonin. 

The majority of antidepressants work by inhibiting a mechanism known as reuptake, which is responsible for flushing serotonin out of your system. Both SSRIs and SNRIs help serotonin accumulate in the brain, which has the effect of improving one's mood.

However, standard antidepressants and talk therapy are not always effective treatments for depression in their patients. 

Traditional antidepressant medications are only effective for around 10–30% of people who use them. These patients either do not notice any improvement at all or only observe limited improvement that fades over time. Even though traditional antidepressants have some side effects, they are generally tolerated by patients.  That being said, many people find the common side effects of traditional antidepressants such as sexual dysfunction, nausea, gastrointestinal dysfunction, insomnia, and more to be bothersome and difficult to tolerate. Many medical professionals, including therapists and doctors, are enthusiastic about the prospect of new treatments like ketamine that work quickly and with few side effects and may be able to assist people who have depression that is resistant to standard treatments.

How to Try Ketamine Therapy?

If you suffer from anxiety and are considering using ketamine therapy as a therapeutic option, you can request a consultation here or discuss your options with your primary healthcare team.

They may be able to recommend a team, like MindWell, that specializes in the use of ketamine for therapeutic purposes.  Learn how to prepare for therapy at MindWell here.

There is a constant growth in the number of standalone ketamine clinics as well as internet services. However, not all of these facilities carry out an appropriate screening or have competent medical specialists on site. So, consider your options carefully. 

Putting it together

There is increasing evidence that supports the use of ketamine for the treatment of anxiety, particularly in situations when other therapies are not producing benefits. However, given the relative novelty of this strategy, it's likely that many more people would benefit than currently know about this option.  We are trying to change that here in Greenville.

If you feel like you may benefit, you can request a consultation.  Also consider talking things over with your primary care physician or a psychiatrist, who will be able to examine your unique situation and determine whether or not ketamine might be a good option for your anxiety.

When treating anxiety with ketamine, it is a good idea to educate yourself about the possible adverse effects and to make arrangements with a reliable guide who can assist you through the experience.  At MindWell, we are here for that.

Keep in mind that ketamine is not a "cure" for anxiety, but research continues to mount and show that for most people it is an extremely effective and even life-changing treatment.