Ketamine for Anxiety: Does It Work? Evidence, Risks and What to Ask a Clinic (2026)

Last reviewed: October 2026

If anxiety treatments haven't worked for you, you may have seen clinics offering ketamine. This guide covers what the research shows, what is still unknown, and how to judge whether a clinic is a good fit.

Does ketamine help anxiety?

It might help for a short time, in some people whose anxiety hasn't improved with standard treatments. The studies are small, the benefits usually fade within days to about two weeks, and ketamine is not FDA-approved for any anxiety disorder. It is best described as an early, promising signal, not a proven treatment.

Is ketamine FDA-approved for anxiety?

No. In its October 10, 2023 safety alert on compounded ketamine for psychiatric disorders, the US Food and Drug Administration said:

Ketamine is approved as an anesthetic, given by IV or intramuscular injection.
It is not approved for treating any psychiatric disorder.
The FDA has not established safe or effective dosing for any psychiatric use.

That means every clinic treating anxiety with ketamine is using it off-label. There is no FDA-set dose, schedule or monitoring standard for anxiety.

Spravato (esketamine) is approved only for depression. According to Spravato's prescribing information on DailyMed, it is approved for adults with:

Treatment-resistant depression. It can be used on its own or with an oral antidepressant. Use on its own was approved in January 2025, announced by Johnson & Johnson on January 21, 2025.
Major depression with acute suicidal thoughts or behavior. It must be used together with an oral antidepressant.

Anxiety is not an approved use. For more on how the two differ, see Ketamine vs. Spravato.

What the research shows for generalized and social anxiety

The research on ketamine for anxiety disorders is real but thin. Here are the main studies.

Taylor and colleagues, 2018. In this trial published in Neuropsychopharmacology, 18 adults with social anxiety disorder each received one IV infusion of ketamine and one of saline placebo, in random order. Clinicians rated anxiety as more improved after ketamine. The participants' own anxiety ratings showed no difference between ketamine and placebo.

Glue and colleagues, 2020. In this trial published in the Journal of Psychopharmacology, 12 adults with hard-to-treat generalized and/or social anxiety received weekly ketamine injections under the skin at increasing doses. A comparison drug, midazolam, was slipped in at random. Anxiety improved within about an hour and the benefit lasted up to a week.

Reviews that pool the studies:

Whittaker and colleagues, 2021 (Therapeutic Advances in Psychopharmacology). They pooled six randomized trials, four of which were positive. The authors called their findings preliminary, and the results for social anxiety came with very wide margins of uncertainty.
Tully and colleagues, 2022 (British Journal of Clinical Pharmacology). Their review of 18 studies with 513 people found early signs that ketamine works for treatment-resistant anxiety. The effects were temporary, lasting up to about a week, and the studies varied widely in route and dose.
Hartland and colleagues, 2023 (Journal of Psychopharmacology). Anxiety was moderately lower 24 hours after ketamine than after placebo, with an effect size (SMD) of -0.44. However, 11 of the 14 included trials had a high risk of bias, and many were not in people with anxiety disorders.

A 2025 analysis of anxiety outcomes from the Ketamine for Adult Depression Study was retracted by the British Journal of Psychiatry on March 31, 2026.

What this means for you: the studies are small and short-term, and most involve people whose anxiety had not responded to other treatment. No large, long-term trial has yet shown that ketamine treats anxiety disorders.

What if I have anxiety along with depression or PTSD?

Many people have more than one condition, and the evidence differs for each.

Depression. The evidence for depression is stronger, and Spravato is approved for it. In a 2021 analysis published in Depression and Anxiety, Daly and colleagues reexamined the TRANSFORM-2 trial. They found esketamine improved depression whether or not patients also had significant anxiety. The analysis was done after the trial ended and measured depression, not anxiety. See Ketamine Therapy for Depression.

PTSD. The results are mixed:

Feder and colleagues, 2021 (American Journal of Psychiatry). In 30 adults with chronic PTSD, six IV ketamine infusions over two weeks worked better than the comparison drug, midazolam.
Abdallah and colleagues, 2022 (Neuropsychopharmacology). This larger trial of 158 veterans and service members found no significant effect on PTSD symptoms.

See Ketamine Therapy for PTSD.

How long does ketamine last for anxiety?

After a single treatment, anxiety relief usually lasted up to about a week in the studies reviewed by Tully and colleagues (2022) and in the trial by Glue and colleagues (2020). Hartland and colleagues (2023) found effects lasting one to two weeks. This is why clinics offer a series of treatments followed by "booster" sessions.

There is no proven maintenance schedule for anxiety. The 2017 consensus statement on ketamine by Sanacora and colleagues, published in JAMA Psychiatry for an American Psychiatric Association task force (coverage in Medscape), treats 0.5 mg/kg by IV over 40 minutes as the reference dose for mood disorders. It does not give anxiety-specific dosing. Ask any clinic what happens if your benefits fade, and how decisions about boosters are made.

Can ketamine make anxiety worse?

It can. Here are the main reasons:

Anxiety as a side effect. Anxiety is among the most common side effects listed in Spravato's prescribing information.
Worsening of psychiatric conditions. The FDA's October 10, 2023 alert lists new psychiatric problems, or worsening of existing ones, as a known ketamine risk.
Dissociation. Feeling detached from your body or surroundings affected 48% to 61% of patients in Spravato trials, according to the FDA-approved Spravato label. For people with anxiety, this can feel unsettling.

Dissociation usually passes during the observation period after treatment. Hartland and colleagues (2023) also found that more intense dissociation did not mean more anxiety relief, so a stronger experience is not a sign it's working better. To know what a session feels like, read What to Expect at a Ketamine Infusion.

IV, nasal spray or at-home: which route?

Route	What to know
IV infusion	Used in most of the trials above. Given in a clinic, with staff monitoring you.
Injection (IM or under the skin)	Offered by some clinics. Glue and colleagues used the under-the-skin route.
Spravato nasal spray	Given only in certified clinics, with at least 2 hours of monitoring, per its label. Approved for depression only.
At-home oral or dissolving tablets	Compounded, prescribed through telehealth. No medical staff on site.

A note on at-home ketamine. The FDA's October 10, 2023 alert said at-home use lacks on-site monitoring. It also described an April 2023 report of dangerously slowed breathing in a patient taking compounded oral ketamine at home for PTSD.

The largest at-home study, by Hull and colleagues (Journal of Affective Disorders, 2022), reported large drops in anxiety scores among 1,247 patients who completed four weeks of treatment through the telehealth company Mindbloom. That study had no control group, several of its authors were affiliated with Mindbloom, and it counted only patients who finished treatment, so treat it as preliminary. More in At-Home Ketamine Therapy.

How much does it cost, and does insurance cover it?

KFF Health News and NPR reported (January 30, 2024) that clinics charge $600 to $1,000 per infusion, and that most insurance does not cover ketamine for mental health. Spravato is more often billed through insurance, but because its label covers only depression, coverage is tied to a depression diagnosis, not anxiety alone.

For verified local prices, see Ketamine Therapy Cost. For financing and reimbursement options, see How to Pay for Ketamine Therapy.

Who shouldn't try ketamine for anxiety

Talk with a doctor first. Ketamine may not be safe for you if any of these apply:

Blood vessel disease or a past brain bleed. Spravato's prescribing information rules out people with aneurysms, arteriovenous malformations or a history of bleeding in the brain.
High blood pressure. The same label warns that blood pressure can rise substantially after any dose.
Pregnancy or breastfeeding. The label warns of possible harm to a fetus and advises against breastfeeding.
A history of psychosis or substance use disorder. Research trials commonly exclude these patients, for example a Massachusetts General Hospital trial (NCT05450432). The FDA classifies ketamine as a Schedule III controlled substance, and the Spravato label carries a boxed warning for abuse and misuse.
Regular sedatives. The Spravato label warns that benzodiazepines, opioids and other sedating drugs can add to its sedation.
Bladder concerns. The label warns of bladder inflammation (cystitis). A 2025 review by Andrade in the Journal of Clinical Psychiatry tied serious bladder damage mainly to heavy recreational use and found no convincing evidence of it at treatment doses. A urology commentary published in response disputes that the risk is negligible. Frequent long-term use is less studied.

What good screening looks like (modeled on the Spravato label):

A review of your medical and psychiatric history.
Blood pressure checks before treatment and at about 40 minutes.
At least 2 hours of observation afterward.
No driving until the next day.

Questions to ask a clinic

Do you treat anxiety off-label, and how do you explain the evidence to patients?
Is a psychiatrist involved in my care?
What screening do you do for blood pressure, heart and blood vessel history, psychosis, substance use and pregnancy?
Who monitors my vital signs during and after treatment, and for how long?
Which routes do you offer, and why would you recommend one for me?
If I also have depression, do you offer Spravato, and are you certified to give it?
Is therapy included, and what does it cost?
What is the total cost of the first series, and do you provide a superbill for insurance?
What is the plan if my benefits fade?

When you're ready, search verified ketamine clinics near you on PsychedelicBeacon, or read How to Find a Ketamine Clinic.

FAQ

How quickly does ketamine work for anxiety? In the trial by Glue and colleagues (2020), anxiety improved within about an hour. Hartland and colleagues (2023) found effects within hours of treatment.

Is ketamine addictive? The FDA classifies ketamine as a Schedule III controlled substance with misuse potential, and the Spravato label carries a boxed warning for abuse and misuse. Supervised, occasional dosing in a clinic lowers that risk but does not remove it.

Is at-home ketamine safe for anxiety? The FDA's October 2023 alert warned that at-home compounded ketamine lacks on-site monitoring. If you choose it, ask who is reachable during sessions and what the emergency plan is.

Will insurance cover ketamine for anxiety? Usually not. KFF Health News and NPR (2024) reported that most insurance does not cover ketamine for mental health, and Spravato coverage is tied to depression.

Can I take ketamine if I'm on benzodiazepines? Tell your prescriber. The Spravato label warns that sedating medications add to sedation, and some trials exclude people who take them often.

Sources

Regulatory and labeling

US Food and Drug Administration. "FDA warns patients and health care providers about potential risks associated with compounded ketamine products, including oral formulations, for the treatment of psychiatric disorders." Safety alert, October 10, 2023. The original page is no longer online.
Spravato (esketamine) prescribing information. DailyMed, National Library of Medicine, accessed October 12, 2026.
Spravato FDA-approved label. Drugs@FDA, 2025.
Johnson & Johnson. "SPRAVATO (esketamine) approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression." Press release, January 21, 2025.

Clinical trials and analyses

Taylor JH, et al. Neuropsychopharmacology, 2018;43(2):325-333.
Glue P, et al. Journal of Psychopharmacology, 2020;34(3):267-272.
Feder A, et al. "A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder." American Journal of Psychiatry, 2021;178(2):193-202.
Abdallah CG, et al. Neuropsychopharmacology, 2022. Linked copy is from an institutional repository.
Daly EJ, et al. Depression and Anxiety, 2021.
Hull TD, et al. Journal of Affective Disorders, 2022;314:59-67.
Retraction notice, Ketamine for Adult Depression Study anxiety analysis. British Journal of Psychiatry, March 31, 2026.
Massachusetts General Hospital trial. ClinicalTrials.gov NCT05450432.

Reviews

Whittaker E, et al. Therapeutic Advances in Psychopharmacology, 2021;11. Published December 15, 2021.
Tully JL, et al. British Journal of Clinical Pharmacology, 2022;88(10):4412-4426. Published May 20, 2022.
Hartland H, et al. Journal of Psychopharmacology, 2023;37(8):764-774.
Andrade C. "Ketamine-associated uropathy." Journal of Clinical Psychiatry, 2025.
Urological commentary on ketamine-associated uropathy. Journal of Clinical Psychiatry, 2025.

Guidance and reporting

Sanacora G, et al. "A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders." JAMA Psychiatry, 2017;74(4):399-405. Coverage in Medscape, March 2, 2017.
KFF Health News and NPR. "The ketamine economy." NPR, January 30, 2024.

Medical disclaimer

This article is for general information only and is not medical advice. Ketamine is not FDA-approved for anxiety. Talk with a licensed clinician before starting or changing any treatment. If you are in crisis or thinking about harming yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline.