Ketamine Therapy for Anxiety in Asheville
For patients with anxiety that has not responded to SSRIs, SNRIs, benzodiazepines, or psychotherapy, ketamine therapy offers a different mechanism. Medically monitored infusion and KAP, physician-led care.
When Anxiety Doesn’t Respond
For most people, anxiety is treatable. Cognitive-behavioral therapy works. SSRIs work. Lifestyle interventions like sleep, exercise, and stress reduction work.
For a meaningful minority of patients, those approaches do not produce adequate response. The reasons vary: medication side effects that make adherence impossible, anxiety severity that overwhelms cognitive interventions, co-occurring conditions that complicate treatment, or genetic and neurobiological factors that make certain pathways less responsive.
If you have tried multiple SSRIs, completed a course of CBT, and still feel ruled by anxiety, you are not alone. You also have more options than you may realize.
Ketamine therapy is one of those options. It is not a first-line treatment for anxiety. It is a clinically considered next step when standard approaches have not been enough.
What the Research Shows
The research base for ketamine in anxiety disorders is smaller than the depression literature but is growing. Key findings:
- Generalized anxiety disorder. Small randomized trials and open-label studies report symptom reduction in patients with treatment-resistant generalized anxiety following ketamine infusions.
- Social anxiety disorder. Limited but emerging evidence suggests ketamine may produce symptom reduction in social anxiety, particularly in patients who have not responded to SSRIs.
- Co-occurring depression and anxiety. Most depression studies that show ketamine response also report improvements in anxious features. The two conditions frequently co-occur, and ketamine appears to affect both.
- Acute relief. As with depression, many patients report symptom reduction within hours to days of infusion, rather than weeks.
The evidence base is less mature than for depression. We discuss the state of the evidence honestly with every patient during medical evaluation.
Anxiety Types We Evaluate
- Generalized anxiety disorder (GAD). Chronic worry, muscle tension, sleep disruption, difficulty concentrating.
- Social anxiety disorder. Significant distress around social and performance situations that impacts daily life.
- Panic disorder. Recurrent panic attacks with anticipatory anxiety. Note: ketamine is not a first-line treatment for panic disorder, and our clinical evaluation may recommend other options.
- Health anxiety. Persistent worry about health and bodily symptoms.
- Anxiety with co-occurring depression. Common pattern. Treatment often addresses both.
We do not treat obsessive-compulsive disorder (OCD) as a primary indication. OCD has its own established treatment protocols, and ketamine evidence for OCD is more limited. Discuss with a psychiatrist specialized in OCD.
Who May Be a Good Candidate
Ketamine therapy may be considered for adults with:
- Generalized anxiety disorder, social anxiety disorder, or treatment-resistant anxiety
- Failure of two or more first-line treatments (SSRIs, SNRIs, CBT)
- Significant functional impairment from anxiety symptoms
- Co-occurring depression and anxiety
- Patients who cannot tolerate side effects of standard anxiety medications
You may not be a candidate if you have:
- Uncontrolled hypertension or cardiovascular disease
- Active psychotic symptoms without psychiatric collaboration
- Severe dissociative pathology (clinical judgment)
- Active substance use disorder (case-by-case review)
- Other conditions identified during evaluation
For anxiety patients specifically, we discuss the dissociative effects of ketamine carefully. Many patients with anxiety initially fear the loss of control associated with dissociation. With proper preparation, most patients find the experience workable. A small minority do not, and that is information we learn together.
What Treatment Looks Like
Phone Consult
Free, about 15 minutes. We answer your questions and confirm whether ketamine therapy is a likely fit. If yes, we schedule your evaluation.
Medical Evaluation
A licensed clinician reviews your medical and mental health history, current medications, prior treatments, and treatment goals. For anxiety patients, evaluation includes specific discussion of what dissociation may feel like and how to prepare for it.
Treatment Series
Most patients begin with 4 to 6 sessions over 2 to 3 weeks. Each session is monitored, with vital signs tracked throughout. The environment is dim, quiet, and private.
Integration
Between sessions, our team is available for questions. Continued work with a therapist or psychiatrist is encouraged. Coordination of care is offered with your written consent.
Maintenance
After the initial series, your clinician will recommend a maintenance schedule based on response.
Ketamine Infusion vs. KAP for Anxiety
For anxiety, the choice depends on the patient’s clinical picture and goals.
Ketamine Infusion Therapy
Offers symptom reduction through repeated dosing. For patients whose primary goal is reducing the intensity of generalized anxiety symptoms, infusion-only therapy often produces meaningful response.
Ketamine-Assisted Psychotherapy (KAP)
A stronger fit when the anxiety is tightly tied to specific themes (relationship patterns, perfectionism, fear of failure, trauma-related anxiety) that benefit from active therapeutic work during the dosing session.
Costs
Ketamine therapy is typically not covered by insurance and is paid out of pocket. HSA and FSA accepted where eligible.
Frequently Asked Questions
Will dissociation make my anxiety worse?
The honest answer is: it depends on the patient. For most patients with anxiety, the dissociative experience is initially unfamiliar but ultimately calming. Many describe a temporary release from the constant alertness of anxiety. A small minority find the experience uncomfortable. Your clinician prepares you for what to expect, and the medical setting helps most patients move through any initial discomfort.
Can I take a benzodiazepine before the session to manage anticipatory anxiety?
Generally not on the day of infusion. Benzodiazepines can blunt ketamine’s effects. Your clinician will guide medication coordination before each session.
Will ketamine make me anxious during the experience?
Some patients experience temporary anxiety or unease during the early minutes of an infusion as the dissociative effects begin. These typically settle within 10 to 15 minutes as the session progresses. Our nursing staff is trained to support patients through this transition.
How is this different from a benzodiazepine?
Benzodiazepines work quickly and produce immediate calming effects, but tolerance develops, dependency is a real risk, and they do not address the underlying neurobiology of anxiety. Ketamine appears to act on different systems (glutamate, synaptic plasticity) and produces longer-acting effects from a smaller number of sessions. The two are not substitutes for each other and are sometimes used in coordinated treatment plans.
Will I have to stop my SSRI?
Usually no. Most patients continue their psychiatric medications during ketamine therapy. Coordination with your prescribing physician is encouraged.
Is the experience scary?
Different patients describe it differently. Most use words like “interesting”, “peaceful”, or “calming”. Some describe it as visually intense. A small minority find it unsettling. The medical environment, preparation, and clinical support help most patients move through any uncertainty.
Ready to Talk?
Book a free 15-minute phone consult. No pressure. We answer your questions and let you decide.
Visit: Hydrate Medical Asheville, 190 Hendersonville Rd Suite 30, Asheville, NC 28803
Ketamine therapy is not appropriate for every patient. A medical evaluation by a licensed clinician is required prior to treatment. Individual results vary. This page is educational and is not a substitute for medical advice. Hydrate Medical does not promise outcomes.
Sources
- Glue P, et al. Ketamine for treatment-resistant social anxiety disorder. Journal of Psychopharmacology, 2017.
- Taylor JH, et al. Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial. Neuropsychopharmacology, 2018.
- Reviews of ketamine in anxiety disorders, Frontiers in Psychiatry, 2022.