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J Psychopharmacol. 2018 Jun;32(6):663-667. doi: 10.1177/0269881118762073. Epub 2018 Mar 21.

Safety and efficacy of maintenance ketamine treatment in patients with treatment-refractory generalised anxiety and social anxiety disorders.

Author information

1
1 Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
2
2 School of Pharmacy, University of Otago, Dunedin, New Zealand.
3
3 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
4
4 Southern District Health Board, Dunedin, New Zealand.
5
5 Department of Psychology, University of Otago, Dunedin, New Zealand.

Abstract

OBJECTIVE:

In this maintenance treatment study, we sought to evaluate the effect on anxiety ratings, safety and tolerability of 3 months of weekly ketamine in 20 patients with treatment-refractory DSM IV generalised anxiety disorder (GAD) and/or social anxiety disorder (SAD), and subsequent assessment of remission post-treatment.

METHODS:

This was an uncontrolled open-label study in 20 patients who had been responders in an ascending dose ketamine study. The study was undertaken in a university clinic. Patients received one or two weekly ketamine doses of 1 mg/kg injected subcutaneously for 3 months. Data were collected from December 2015-June 2017.

RESULTS:

There were 10 women (50%) and 10 men (50%); 15 patients (75%) met criteria for GAD and 18 (90%) for SAD. One hour after dosing, Fear Questionnaire ratings decreased by ~50%, as did Hamilton Anxiety ratings. Clinician Administered Dissociative States Scale mean scores declined over time, from 20 points at week 1 to 8.8 points at week 14. Compared with pre-dose values, mean systolic and diastolic blood pressure increased by ~10 mm Hg at 30 min. The most common adverse events were nausea, dizziness and blurred vision. Of the 20 patients, 18 reported improved social functioning and/or work functioning during maintenance treatment.

CONCLUSIONS:

Weekly ketamine dosing was safe and well tolerated, and post-dose dissociative symptoms tended to reduce after repeated dosing. Patients reported marked improvements in functionality and in their personal lives. Maintenance ketamine may be a therapeutic alternative for patients with treatment refractory GAD/SAD.

TRIAL REGISTRATION:

http://www.anzctr.org.au/ACTRN12615000617561.

KEYWORDS:

Ketamine; generalised anxiety disorder; maintenance treatment; social anxiety disorder

PMID:
29561204
DOI:
10.1177/0269881118762073

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