Ketamine treatment for refractory anxiety: A systematic review

There is a growing interest in the psychiatric properties of the dissociative anaesthetic ketamine, as single doses have been shown to have fast‐acting mood‐enhancing and anxiolytic effects, which persist for up to a week after the main psychoactive symptoms have diminished. Therefore, ketamine pose...

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Published in:British journal of clinical pharmacology 2022-10, Vol.88 (10), p.4412-4426
Main Authors: Tully, Jamie L., Dahlén, Amelia D., Haggarty, Connor J., Schiöth, Helgi B., Brooks, Samantha
Format: Article
Language:English
Subjects:
Anti-Anxiety Agents - therapeutic use
anxiety
Anxiety - drug therapy
Anxiety - psychology
Anxiety Disorders - drug therapy
anxiolytic
depression
Humans
ketamine
Ketamine - therapeutic use
ketamine infusion
Receptors, N-Methyl-D-Aspartate
refractory anxiety
treatment-resistant depression
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Summary:There is a growing interest in the psychiatric properties of the dissociative anaesthetic ketamine, as single doses have been shown to have fast‐acting mood‐enhancing and anxiolytic effects, which persist for up to a week after the main psychoactive symptoms have diminished. Therefore, ketamine poses potential beneficial effects in patients with refractory anxiety disorders, where other conventional anxiolytics have been ineffective. Ketamine is a noncompetitive antagonist of the N‐methyl‐d‐aspartate (NMDA) glutamate receptor, which underlies its induction of pain relief and anaesthesia. However, the role of NMDA receptors in anxiety reduction is still relatively unknown. To fill this paucity in the literature, this systematic review assesses the evidence that ketamine significantly reduces refractory anxiety and discusses to what extent this may be mediated by NMDA receptor antagonism and other receptors. We highlight the temporary nature of the anxiolytic effects and discuss the high discrepancy among the study designs regarding many fundamental factors such as administration routes, complementary treatments and other treatments.
ISSN:0306-5251
1365-2125
1365-2125
DOI:10.1111/bcp.15374