Ketamine is a medicine that was first used as an anaesthetic. In recent years, researchers have studied low doses of ketamine for depression and, more recently, for anxiety, especially in people whose symptoms have not improved with standard treatments. This guide explains what is known so far about how quickly it may work, how it is given and what the risks are.
Important: ketamine for anxiety is a specialist treatment that is only given under medical supervision. It is not a self-help option.
The short answer
In studies, some people report feeling less anxious within hours to a day of a ketamine treatment. That is much faster than standard anxiety medicines, which usually take several weeks to work. The effect of a single dose tends to fade over days to a couple of weeks, so treatment usually involves a series of sessions. Research on ketamine for anxiety is still limited, and it is not a standard first treatment.
How ketamine may work
Most anxiety and depression medicines act on serotonin. Ketamine works differently: it affects glutamate, one of the brain’s main chemical messengers, by blocking a receptor called NMDA. Researchers think this may help the brain form new connections quickly, which could explain its fast effect, but the exact mechanism is still being studied.
Is ketamine approved for anxiety?
Not in the US. The only ketamine-based medicine approved by the US Food and Drug Administration for a mental health condition is esketamine (brand name Spravato), a nasal spray approved for treatment-resistant depression and for depression with suicidal thoughts or actions. When ketamine is used for anxiety, it is prescribed “off-label”, which means outside its approved use.
How ketamine treatment is given
- Intravenous (IV) infusion: a slow drip into a vein in a clinic, often over about 40 minutes. This is the form most often studied.
- Nasal spray: esketamine is given in a certified clinic, where you are monitored for at least two hours afterwards.
- Injection: an injection into a muscle, given in a clinic.
- Tablets or lozenges: some clinics prescribe these for use at home, but there is less research on them and less supervision.
A course often starts with several sessions over two to three weeks, followed by less frequent sessions if the treatment helps. Plans vary between clinics.
Side effects and risks
During and shortly after a session, common side effects include:
- feeling detached or “outside your body” (dissociation)
- dizziness, drowsiness or blurred vision
- nausea
- a rise in blood pressure and heart rate
Because of these effects, you should not drive or operate machinery until the next day, and you will need someone to take you home. Ketamine can also be misused, and regular heavy use is linked with dependence, memory problems and bladder damage. It is not suitable for everyone, for example people with some heart conditions, uncontrolled high blood pressure, a history of psychosis or substance misuse, or who are pregnant.
Who might consider it
Ketamine is usually considered only after other treatments, such as talking therapies and standard medicines, have been tried without enough improvement. A psychiatrist should assess whether it is right for you, and treatment should take place in a licensed clinic that monitors you during and after each session. It tends to work best as one part of a wider plan that includes therapy and support.
Questions to ask before starting
- What does the research say about ketamine for my type of anxiety?
- Which form of ketamine do you use, and how will I be monitored?
- How many sessions are planned, and what happens if it does not help?
- What does it cost, and is any of it covered by insurance?
- How will it work alongside my current medicines and therapy?
The bottom line
Ketamine may ease anxiety faster than standard treatments for some people, but the evidence is still early, the effect of a single dose is short-lived, and it carries real risks. If anxiety is affecting your daily life, start by talking to your doctor about the treatments available to you.
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