Ketamine's dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders

J Psychopharmacol. 2017 Oct;31(10):1302-1305. doi: 10.1177/0269881117705089. Epub 2017 Apr 26.


The N-methyl-D-aspartate receptor antagonist ketamine has rapid onset activity in treatment-resistant depression, post-traumatic stress disorder and obsessive compulsive disorder. Due to similarities in brain network activity in depression and anxiety disorders, we hypothesized that ketamine might also be active in other refractory anxiety disorders. We evaluated the efficacy and safety of ketamine in 12 patients with refractory generalized anxiety disorder and/or social anxiety disorder who were not currently depressed, using an ascending single dose study design (0.25, 0.5, 1 mg/kg administered subcutaneously) at weekly intervals. Within 1 h of dosing, patients reported reduced anxiety, which persisted for up to seven days. A dose-response profile was noted for anxiolytic effects, dissociative side effects, and changes in blood pressure and heart rate, with minor changes at 0.25 mg/kg, and progressively greater and more durable changes at the higher doses. Ten of 12 patients were treatment responders at 0.5-1 mg/kg. Ketamine was safe and well tolerated in this population. Ketamine may be a potential therapeutic alternative for patients with refractory generalized anxiety disorder/social anxiety disorder. Along with its demonstrated effectiveness in patients with treatment-resistant depression, obsessive compulsive disorder and post-traumatic stress disorder, these data raise the intriguing possibility that ketamine may have broad efficacy in disorders characterized by negative emotional states, and that these disorders may share a common precipitating neurobiology.

Keywords: Ketamine; dose-response; generalized anxiety disorder; social anxiety disorder.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Anti-Anxiety Agents / therapeutic use
  • Antidepressive Agents / therapeutic use*
  • Anxiety / drug therapy*
  • Anxiety / metabolism
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / metabolism
  • Depression / drug therapy*
  • Depression / metabolism
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / metabolism
  • Depressive Disorder, Treatment-Resistant / drug therapy
  • Depressive Disorder, Treatment-Resistant / metabolism
  • Female
  • Humans
  • Ketamine / therapeutic use*
  • Male
  • Middle Aged
  • Obsessive-Compulsive Disorder / drug therapy
  • Obsessive-Compulsive Disorder / metabolism
  • Receptors, N-Methyl-D-Aspartate / metabolism
  • Stress Disorders, Post-Traumatic / drug therapy
  • Stress Disorders, Post-Traumatic / metabolism
  • Young Adult


  • Anti-Anxiety Agents
  • Antidepressive Agents
  • Receptors, N-Methyl-D-Aspartate
  • Ketamine

Associated data

  • ANZCTR/ACTRN12615000617561