Low-Dose Ketamine for Anxiety

Anxiety is a natural response when people face a situation out of their comfort zone. Few people get through life without experiencing anxiety. But some forms of anxiety can be severe, long-lasting, and crippling, and even prevent a person from living the quality of life they deserve. A constant state of high alert or worry that lasts for six months or more may signal an anxiety disorder.

The American Psychological Association (APA) describes anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” Those with severe anxiety may suffer from recurring negative thoughts and physical symptoms like sweating, trembling, dizziness, or a rapid heartbeat, similar to the well documented "fight or flight" fear response.

The difference between fear and anxiety, explains the APA, is that while "fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat,” anxiety is “a future-oriented, long-acting response broadly focused on a diffuse threat." In other words, fear focuses on an imminent threat, while anxiety is much more generalized and future based.

Doctors have prescribed specific classes of medications to treat anxiety symptoms for decades. Many people have found relief, at least temporarily, from one or more prescribed medications, but traditional anxiety drugs do not help and may even cause harm for others. Several researchers have identified ketamine as a potentially safer, more effective approach to resolving anxiety disorders.

What is an Anxiety Disorder?

Anxiety disorders are a group of mental health conditions with similar symptoms that affect how a person reacts to certain situations or emotions. While anxiety can be a natural response critical for survival, a person with an anxiety disorder often exhibits fear, nervousness, and apprehension that is out of proportion to the situation.

According to the Anxiety and Depression Association of America, anxiety is the most common mental illness in the country, with about 40 million people suffering from the disorder. Sadly, less than 40 percent of those with an anxiety disorder receive needed treatment.

Health professionals rely on the current version of the Diagnostic and Statistical Manual of Mental Health Disorders: Fifth Edition (DSM-V) for direction in diagnosing mental health conditions.

The DSM-5 provides diagnostic guidelines for the following major types of anxiety disorders:

• Generalized Anxiety Disorder (GAD) – chronic anxiety and excessive worry over nonspecific events. The person may feel edgy and irritable, have trouble focusing, experience unhealthy sleep patterns, and worry excessively.
• Post-Traumatic Stress Disorder (PTSD) – may occur after a traumatic event where the person feels their life is in danger. Symptoms may include nightmares or flashbacks, withdrawal from people or activities previously enjoyed, and avoidance of people or situations that remind them of the trauma.
• Obsessive-Compulsive Disorder (OCD) – may present as obsessive unwanted thoughts or repetitive behaviors, or both. Performing set “rituals” like flicking a light switch a specific number of times may briefly relieve anxiety, but the anxiety quickly returns.
• Panic Disorder (PD) – abrupt, intense fear that triggers symptoms like chest pain, racing and pounding heart, trouble breathing, trembling, and an overwhelming sense of danger.
• Social Anxiety Disorder (SAD) – crippling self-consciousness and fear of judgment in social situations. SAD may occur only in certain situations like public speaking or may trigger overwhelming anxiety in any social interaction.

The root cause of chronic anxiety varies for each person and often includes a combination of factors. Various studies find people whose backgrounds have one or more of the following are at a greater risk of developing an anxiety disorder:

• On-going stress
• Childhood abuse or trauma
• A close relative with an anxiety disorder
• Substance abuse
• A stressful job
• Depression or another mood disorder
• A chronic medical condition

For decades, doctors have prescribed certain medications to relieve symptoms of anxiety. Traditional anxiety medications may help some, but their use is not without risk.

The Drawbacks of Traditional Anxiety Medications

Most doctors recommend a combination of psychotherapy and prescription medications to treat anxiety disorders. Unfortunately, many anxiety medications carry a high risk of abuse or addiction and may have dangerous side effects.

Doctors most often prescribe the following classes of anxiety medications:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRI)
• Benzodiazepines
• Tricyclics

SSRIs are one of the most frequently prescribed medications but studies suggest they may take 4-6 weeks to provide relief and may cause uncomfortable side effects when stopped. Benzodiazepines (benzos) work more quickly but are meant for short-term use, as they increase a person's risk of addiction if used longer than four weeks.

Combining benzos with opioids is extremely dangerous and can cause respiratory depression, coma, brain damage, and death.

How Does Low-Dose Ketamine Differ from Traditional Anxiety Medications?

A study published in Pharmacology and Therapeutics identified ketamine as a promising therapy for generalized anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.

Various researchers label ketamine as a “novel pharmacological agent” in treating anxiety and anxiety-related disorder with a low risk of adverse effects. A novel pharmacological agent is a biologically active substance that has a therapeutic effect on the body.

Long-term anxiety and depression damage connections in the areas of the brain that regulate functions such as mood, memory, and learning. Scientists believe it's the way ketamine interacts with glutamate, a chemical messenger in the brain, that helps to repair and even form new neural connections that effectively lessen anxiety and lift the mood.

Upon ingestion, ketamine almost immediately affects glutamate levels, quickly reducing the symptoms and severity of anxiety, sometimes within two hours. Studies find ketamine also improves cognitive function, impulse control, and emotional regulation. A randomized controlled trial published in the journal Neuropsychopharmacology concluded that ketamine’s effect on glutamate neurotransmission could reduce OCD symptoms.

Unlike ketamine, traditional anxiety medications do not immediately target glutamate but initially work to increase the activity of brain chemicals like serotonin, which regulates mood. While higher levels of serotonin may eventually improve mood, people may find it to be a slow and frustrating journey to get there. Recent studies have also found that around 30% of those who use SSRIs receive little to no relief from their anxiety or depression.

Besides waiting several weeks to know whether they will receive any relief from anxiety symptoms, people commonly experience uncomfortable side effects with these medications.

• SSRIs, SNRIs, and Tricyclics have similar side effects, including feeling shaky, agitated, or sick, diarrhea or constipation, dizziness, sleep problems, excessive sweating, and sexual dysfunction.
• Benzodiazepines carry a high risk for dependence or addiction. Side effects may include feeling drowsy, light-headed, confused, or dizzy, muscle weakness, memory problems, cognitive decline, and nausea. Benzos are especially dangerous when combined with opioids which can result in extreme fatigue, dangerously slow breathing, coma, or death.

In low doses, ketamine presents little risk for dependence or unwanted side effects when taken as directed by a doctor in a clinical setting. And although there is far more research on the benefits of ketamine for treating depression, studies also find it effective for anxiety. A recently published meta-analysis evaluating ketamine for anxiety disorders found ketamine is safe and effective, even for treatment-resistant anxiety spectrum disorders. Most study participants achieved an excellent treatment response, including improved social or work functioning.

Ketamine Adds a Positive and Unique Dimension to Psychotherapy

Most experts agree the proper medication combined with psychotherapy provides the most significant benefits to those struggling with anxiety and other mental health conditions. Because of its unique effects, low-dose ketamine can help individuals achieve a frame of mind that is open to self-examination and change, which can speed their healing journey.

Very low-dose ketamine can help people view anxiety symptoms from a distance, so they can dispassionately study the emotions and sensations triggered by anxiety. Because low-dose ketamine does not cause a psychedelic effect, therapy can be a calm, enlightening experience rather than one fraught with intense images that can be frightening.

Simply put, low-dose ketamine therapy can help blunt the edges of anxiety symptoms so the person can concentrate on healing. Individuals remain lucid and aware of their surroundings while under the influence of low-dose ketamine. They can work with their therapist to identify the root causes of their anxiety, gain new perspectives as they reframe past events, and embrace a new way of thinking.

Researchers at Yale and other noted institutions are excited about the breadth of studies that support the effectiveness of ketamine in treating intermittent anxiety, generalized anxiety disorder, social anxiety disorder, depression, panic disorders, OCD, PTSD, agoraphobia, and other phobias.

Unlike traditional medications, ketamine users may not have to commit to long-term, everyday use to avoid a relapse of anxiety symptoms. As they work with their health professional to find the dose that works best, many low-dose ketamine users find there comes a point where they can space out doses, eventually just using it as needed.

Learn more about very low-dose ketamine and how it may help you overcome the endless loop of worry and fear that is chronic anxiety. The expert team at Joyous looks forward to talking to you about how we have helped thousands safely achieve clarity, self-love, and mental well-being.