Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial.
Jerome H Taylor, Angeli Landeros‐Weisenberger, Catherine Coughlin, Jilian Mulqueen, Jessica A. Johnson, Daniel Gabriel, Margot O Reed, Ewgeni Jakubovski, Michael H. Bloch
Neuropsychopharmacology August 29, 2017 DOI: 10.1038/npp.2017.194 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Double-blind, randomized, placebo-controlled crossover trial Peer reviewed |
|---|---|
| Sample size | 18 |
| Population | Adults with DSM-5 social anxiety disorder |
| Interventions | Ketamine Placebo (normal saline) |
| Dose | 0.5 mg/kg over 40 min |
| Duration | 14-day follow-up after each infusion, with a 28-day washout between infusions |
| Measures | Liebowitz Social Anxiety Scale (LSAS), visual analog scale (VAS-Anxiety) |
| Topics | Ketamine Anxiety Esketamine |
| Keywords | Humans Receptors, n-methyl-d-aspartate Anti-anxiety agents Cross-over studies Double-blind method Female Young adult Phobia, social |
| Key findings | Ketamine reduced social anxiety symptoms significantly more than placebo on the Liebowitz Social Anxiety Scale over 14 days, but not on a self-reported visual analog scale. Response rates in the first two weeks were higher after ketamine than placebo on both measures (33.33% vs 0% on LSAS; 88.89% vs 52.94% on VAS). The authors conclude this proof-of-concept trial provides initial evidence that ketamine may be effective in reducing anxiety. |
Abstract
Many patients with social anxiety disorder (SAD) experience inadequate symptom relief from available treatments. Ketamine is a potent N-methyl-D-aspartate receptor antagonist with a potentially novel mechanism of action for the treatment of anxiety disorders. Therefore, we conducted a double-blind, randomized, placebo-controlled crossover trial in 18 adults with DSM-5 SAD and compared the effects between intravenous ketamine (0.5 mg/kg over 40 min) and placebo (normal saline) on social phobia symptoms. Ketamine and placebo infusions were administered in a random order with a 28-day washout period between infusions. Ratings of anxiety were assessed 3-h post-infusion and followed for 14 days. We used linear mixed models to assess the impact of ketamine and placebo on anxiety symptoms. Outcomes were blinded ratings on the Liebowitz Social Anxiety Scale (LSAS) and self-reported anxiety on a visual analog scale (VAS-Anxiety). We also used the Wilcoxon signed-rank test to compare the proportion of treatment responders. Based on prior studies, we defined response as a greater than 35% LSAS reduction and 50% VAS-Anxiety reduction. We found ketamine resulted in a significantly greater reduction in anxiety relative to placebo on the LSAS (Time × Treatment: F9,115=2.6, p=0.01) but not the VAS-Anxiety (Time × Treatment: F10,141=0.4, p=0.95). Participants were significantly more likely to exhibit a treatment response after ketamine infusion relative to placebo in the first 2 weeks following infusion measured on the LSAS (33.33% response ketamine vs 0% response placebo, Wilcoxon signed-rank test z=2.24, p=0.025) and VAS (88.89% response ketamine vs 52.94% response placebo, Wilcoxon signed-rank test z=2.12, p=0.034). In conclusion, this proof-of-concept trial provides initial evidence that ketamine may be effective in reducing anxiety.
Comparable studies
Other randomized controlled trials on ketamine for anxiety, most cited first.
Citations in the library
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- Ketamine treatment for depression: a review Discover Mental Health April 15, 2022
- An update on ketamine and its two enantiomers as rapid-acting antidepressants Expert Review of Neurotherapeutics December 4, 2018
- Effects of ketamine in patients with treatment-refractory generalized anxiety and social anxiety disorders: Exploratory double-blind psychoactive-controlled replication study Journal of Psychopharmacology March 1, 2020
- Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review Nutrients November 20, 2021
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Cites 11
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- Measurement of dissociative states with the Clinician‐Administered Dissociative States Scale (CADSS) Journal of Traumatic Stress 1998
- Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder JAMA Psychiatry April 16, 2014
- Single-dose infusion ketamine and non-ketamine N-methyl-D-aspartate receptor antagonists for unipolar and bipolar depression: a meta-analysis of efficacy, safety and time trajectories Psychological Medicine February 12, 2016
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