Navigating Ketamine for Anxiety Disorders
Ketamine has evolved from a medicine primarily used for anesthesia to a promising therapeutic agent for treating mental health conditions, including anxiety. Ketamine decreases defensive systems and increases neuroplasticity – the ability of neural networks in the brain to change through growth and reorganization – making it a powerful tool to catalyze an altered state of consciousness.
It impacts the brain similarly to other psychedelics, but through a different neuroscientific mechanism, offering new alternatives for those struggling with anxiety disorders. Ketamine’s effects allow people to step back from their bodies and allow for a new perspective in the processing of traumatic responses.
The History of Ketamine
Originally developed as an anesthetic, ketamine’s journey in medical science has been unique. Since its introduction into clinical practice in the 1960s, ketamine has been used worldwide in operating rooms as a general anesthetic for people from ages 6 to 65 due to its robust safety profile and effectiveness. It also became a popular recreational drug known as “Special K,” which negatively affected its reputation due to its inclusion in War on Drugs campaigns.
Slowly and steadily, ketamine has increased its presence in Western medical and mental health models through off-label clinical use in treating both mental health conditions and chronic pain, and FDA-approved Spravato – a ketamine nasal spray that has been approved to treat treatment-resistant depression.
Ketamine in the Research
Ketamine has more research than other psychedelics, due to its legality for medical use for decades. Studies indicate that ketamine may work by promoting the growth of neural connections, which can be impaired in conditions like depression and anxiety. This research underpins the therapeutic potential of ketamine in treating these conditions. Some highlights are:
- Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature, published in Journal of Pain Research by Drozdz et al, 2022
- Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy, published in Journal of Psychoactive Drugs, by Dore et al, 2019
- Ketamine treatment for refractory anxiety: A systematic review published in the British Journal of Clinical Pharmacology, by Tully et al, 2022
What does Ketamine Feel Like?
Given its unique nature as a dissociative, ketamine induces non-ordinary states that can be slightly different from classical psychedelics like psilocybin and LSD, but share certain qualities.
- Muscle relaxation, pain relief, drowsiness
- Changes in perception, cognition, emotion
- Vivid imagery
- Altered auditory perception and proprioception
- Mood enhancement; feeling of awe/wonder
- Out-of-body experiences, ego dissolution, mystical experiences, death and rebirth experiences
Many clients who experience anxiety and PTSD can be overwhelmed by body sensations, and Ketamine’s unique dissociative quality allows for a fresh perspective, helping a client process unmetabolized somatic responses and explore challenges with curiosity, self-compassion, and acceptance.
Negative experiences are also subjective, so this guide is not comprehensive. Challenging experiences hold the potential for developing new neural pathways (e.g., healing, changing a belief system, changing a patterned emotional response, etc.). This list includes indicators of various levels of challenge and crisis.
- Muscle trembles or jerks
- Decreased concentration, recall, recognition, and mental sharpness
- Double or blurred vision
- Increased intraocular eye pressure
- Increased blood pressure, heart rate
- Vomiting, dizziness
- Decreased conscious breathing
- Laryngospasm
- Blunted affect or emotional withdrawal
- Psychological distress, e.g., anxiety, paranoia, dysphoria, distorted perceptions of body and self
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It’s important to note that each experience is unique to the individual and is greatly influenced by the user’s mindset and setting, so careful preparation before and integration afterwards is crucial to an experience.
Ketamine is not for everyone. This list of contraindications is based on research data through 2023, and is not exhaustive. Care providers need to remain aware of any new data released on contraindications for the medicines they work with. As ketamine is legal for medical use across the United States, it inherently has more data, and hence, a longer list of contraindications.
- Hypertension
- Preeclampsia
- Eclampsia
- Severe cardiac disease
- Stroke
- Raised intracranial pressure
- Acute porphyria
- Epilepsy
- Schizophrenia
- Alcoholism
Is Ketamine a Psychedelic? And does that matter?
Ketamine is often classified as a dissociative anesthetic, but it also has psychedelic “mind-manifesting” properties when administered at sub-anesthetic doses. Ketamine can catalyze profound experiences similar to psilocybin and MDMA.
Ketamine in Psychedelic-Assisted Therapy for Anxiety
The use of ketamine in psychedelic-assisted therapy combines the physiological effects of ketamine with psychotherapy, offering a holistic treatment that considers the whole person’s experience as opposed to just symptom relief. Research and anecdotes alike have shown that, while ketamine itself can produce acute symptomatic relief, the real lasting results are more likely when the user conducts deep self-work, using ketamine not as a “magic pill’ but as a catalyst for lasting behavior change.
Ketamine has been reported to be most effective with repeat sessions, with four to six ketamine sessions and accompanying therapeutic support over a three to four week period being generally considered an optimal course of treatment. The sessions are typically shorter than other psychedelics – lasting from 45 to 90 minutes long, depending on the dose and metabolism of the individual.
Ketamine has been shown to positively affect social anxiety disorder and refractory anxiety in research, and thousands of people around the US and Canada are working with ketamine clinics for relief from these anxiety symptoms.
How to Work with Ketamine for Anxiety
Ketamine is available in the United States for use in treating conditions like chronic pain and generalized anxiety disorder via prescription from a psychiatrist, medical doctor, nurse practitioner, or other prescribing authority, making ketamine the most legally accessible psychedelic. As a result, ketamine-based clinics are rising in popularity as people look to access psychedelic therapy.
There are a few different categories of ketamine therapy, including:
- Ketamine-assisted therapy clinics, offering a more comprehensive support system with in-clinic supervision from medical staff as well as behavioral support from therapists and/or coaches.
- IV-based clinics, offering a package of ketamine infusions over a multiple-hour period with in-clinic supervision, typically from an MD.
- At-home ketamine programs, offering self-paced and virtually supported care with therapists and/or other support specialists.
Ultimately, it’s at the clinic’s discretion on whether or not they offer therapeutic support around the experiences. For example, IV-based clinics tend to have less therapeutic and psychological support as their clientele is typically more focused on treating physical conditions, such as fibromyalgia and chronic pain. Ketamine-assisted therapy clinics tend to emphasize a more holistic program that helps integrate therapeutic gains into daily life. This can include working with a therapist or other support specialist.
What is the Next Step?
There are many organizations offering psychedelic training programs, so it’s up to you to decide which course is right for you. At Beckley Academy, we offer two courses designed to meet the needs of your schedule, profession, preferred learning style, and more. One offers rigorous learning in an online flipped classroom setting for therapists while the other offers asynchronous essentials for anyone on the spectrum of care.
If you’re a therapist and you’d like to learn more about our course offering a deep, transformative, cohort-driven journey into psychedelic practice, download our syllabus for Relational Psychedelic-Assisted Therapy.
If you’re elsewhere on the spectrum of care – a nurse, doctor, guide, coach – eager to learn psychedelic care practices, download our syllabus for Essentials of Psychedelic Care.
Beckley Academy: Leading the Way in Psychedelic Training
At Beckley Academy, we recognize the potential of ketamine and other psychedelics as promising mental health treatments. Our comprehensive training program for licensed therapists is designed to equip practitioners with the knowledge, skills, and ethical understanding.
Our curriculum explores the limitations and gains of scientific research while emphasizing relational and cultural ethics, emphasizing the importance of a strong therapeutic relationship and cultural responsiveness. We are careful to ensure that our commitment to trauma-informed and inclusive education is reflected in every aspect of our teaching.
Our curriculum is medicine-agnostic, ensuring that practitioners have the integral skills to facilitate healing journeys for non-ordinary states of consciousness regardless of the psychedelic catalyst.