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Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: a review of the literature

Published online by Cambridge University Press:  24 July 2019

Michael D. Banov*
Psychatlanta/Northwest Behavioral Research Center, 1012 Coggins Place NE, Marietta, GA 30060, United States Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA30912, United States
Jonathan R. Young
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC27710, United States
Tyler Dunn
Psychatlanta/Northwest Behavioral Research Center, 1012 Coggins Place NE, Marietta, GA 30060, United States
Steven T. Szabo
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC27710, United States Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC27705, United States
*Address correspondence to: Michael D. Banov, Psychatlanta/Northwest Behavioral Research Center, 1012 Coggins Place NE, Marietta, GA 30060, USA. (Email:


Anxiety disorders are among the most prevalent psychiatric conditions. Despite many proven pharmacological and non-pharmacological treatments available, high rates of partial response and low rates of long-term remission remain. Ketamine has been receiving increasing attention as an interventional treatment modality in psychiatry, especially among refractory conditions, including major depressive disorder. There is limited yet growing evidence to support the use of ketamine in anxiety disorders. In this review of the literature, we present case reports, case series, and controlled trials demonstrating proof-of-concept for its potential role in the treatment of anxiety and anxiety spectrum disorders. Its unique mechanism of action, rapid onset, and high rate of response have driven its use in clinical practice. Ketamine is generally well tolerated by patients and has a limited side effect profile; however, the effects of long-term use are unknown. While there is a growing body of research and increasing clinical experience to suggest ketamine may have clinical applications in the treatment of refractory anxiety disorders, further research to determine long-term safety and tolerability is indicated.

© Cambridge University Press 2019

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