Anxiety can make everything harder to manage: concentration, sleep, and even getting through a routine day. When those feelings stick around for weeks or months, people naturally start looking for better options. In recent years, more people have started asking about ketamine therapy.
There’s a reason for the interest. Early studies suggest that ketamine may relieve anxiety symptoms quickly in some people. But that’s only part of the picture.
Most clinicians don’t jump straight to ketamine treatment for anxiety alone. They look at diagnosis, treatment history, severity, and other risks before making that call. For people who feel like they’ve already tried everything, that kind of careful evaluation matters.
This blog unpacks how psychiatric providers think through the question. It also shows why ketamine in Sacramento is offered under medical supervision, and why that supervision is more than a formality.
Why Anxiety Alone Is Rarely the Starting Point for Ketamine
Most people experiencing anxiety aren’t offered ketamine therapy as their first step, or their second.
Therapy is often the first step in standard anxiety treatment. There is strong evidence that cognitive behavioral therapy, exposure work, and trauma-informed models work. In some cases, a doctor may also suggest medications like SSRIs or SNRIs. These treatments may take some time, but they are usually safe, easy to get, and well-studied.
If someone still feels anxious after trying one option or even two, it’s easy to assume they need something more advanced. But ketamine treatment is not meant to replace core care. Instead, it’s a potential option for cases where anxiety doesn’t respond over time, especially when other conditions complicate the picture.
When Persistent Anxiety Signals a More Complex Clinical Picture
Not all anxiety feels the same or stems from the same place. Some people deal with situational stress that never quite resolves. Others live with a chronic sense of restlessness, fear, or tension that no amount of reassurance seems to quiet. Then there are cases where anxiety overlaps with depression so closely that the two are hard to separate.
That overlap is one of the main reasons clinicians begin to consider ketamine for depression in patients who also experience anxiety. The FDA doesn’t currently approve ketamine for psychiatric conditions, but many evaluations, such as the VA’s, center on treatment-resistant depression. If anxiety is part of a broader mood disorder that hasn’t responded to traditional care, that opens a different set of conversations.
The presence of depression also changes how urgent symptoms feel. Someone struggling with suicidal thinking and deep emotional numbness may need relief faster than conventional medications can provide. Ketamine’s fast-acting effects may be relevant there, but again, that’s not the norm.
What “Treatment-Resistant” Actually Means in Psychiatric Care
In clinical settings, treatment resistance typically indicates that the patient has attempted at least two distinct antidepressants at appropriate dosages for a sufficient duration, generally six to eight weeks, without notable improvement.
Sometimes, additional strategies like medication augmentation or psychotherapy are added. If none of those efforts lead to relief, and if the person still has moderate to severe symptoms, the diagnosis may shift toward treatment resistance.
This process matters because ketamine therapy isn’t a shortcut. It’s a layered decision that assumes everything else has been tried and tracked properly. A clinician may also use symptom-rating tools like the PHQ-9 to quantify progress. In the VA system, for instance, a score of 15 or higher on that scale is often one of the markers for severity.
That level of documentation helps protect patients. It also helps providers gauge whether psychiatric treatment with ketamine would add value or just add risk.
Safety, Screening, and Why Supervision Matters
Even when someone meets the clinical criteria, that’s only part of the evaluation. The next step is assessing whether they’re medically and psychologically a good fit for ketamine treatment.
There are clear safety concerns providers must rule out. A history of psychosis or bipolar disorder, for example, would generally exclude someone from receiving ketamine. So would uncontrolled blood pressure or serious heart issues. In some cases, drug screens are used to check for recent misuse or potential interactions.
Physical effects also matter. Ketamine can cause short-term dissociation, sedation, and elevated blood pressure. For someone with high anxiety, especially if they already experience panic or physical symptoms, those side effects can be distressing.
Ketamine is typically given in a medical setting where vital signs can be watched closely. In VA protocols, clinicians monitor blood pressure during IV infusions and may stop if readings rise too high. Some clinics use intranasal esketamine, which requires separate safety steps due to side effects like nausea, dizziness, or disorientation that can follow dosing.
How Clinicians Decide Whether Ketamine Is the Right Next Step
Clinicians don’t rely on one symptom or label to decide if ketamine is appropriate. They look at the full picture, including diagnosis, treatment history, and how a person is functioning day to day. Someone might report classic signs of depression, like low energy and hopelessness, but after a closer look, their main issue could stem from unresolved trauma, panic episodes, or something else entirely. That’s why careful assessments come first.
Before recommending ketamine for depression, most providers ask: Has the individual completed standard treatment options at the right dose and for the right amount of time? Were they forced to stop early due to side effects or other obstacles? Are the current symptoms manageable enough for outpatient care, or would a different level of support be safer? They also weigh risks, like dissociation or blood pressure spikes, that can sometimes make ketamine therapy unsuitable for certain patients. Every factor plays a role.
Choose a Care Team That Treats the Whole Picture
Not all providers approach psychiatric treatment the same way. Some centers offer ketamine treatment without the full clinical support behind it. That can be risky. If there’s no structured evaluation before starting or no follow-up to measure outcomes, people can end up with more questions than answers.
The right care team will go deeper. They’ll ask about previous therapy, how medications affected you, and what you hope will change. They’ll also prepare you for the experience, not just the drug itself, but what it could bring up emotionally or physically. That kind of attention to detail makes a difference.
At Zeam, we offer medically supervised ketamine therapy in Sacramento, Folsom, or Roseville through personalized psychiatric care. If you’ve tried standard options for anxiety treatment and still feel stuck, we’re here to talk through what comes next.
Key Takeaways
- Ketamine is not typically a first-line treatment for anxiety and is usually considered only after standard therapies fail.
- Clinicians look for treatment-resistant depression or complex overlapping conditions, not anxiety alone, when evaluating ketamine eligibility.
- Medical screening is essential, as ketamine can affect blood pressure, dissociation, and psychological stability.
- Supervised clinical settings reduce risk and ensure ketamine is used appropriately and safely, especially compared to unsupervised or compounded formulations.
- A careful, whole-person evaluation helps determine whether ketamine adds real value or unnecessary risk.
Citations & Sources
- U.S. Department of Veterans Affairs – Ketamine Infusion Guidance
https://www.va.gov/COMMUNITYCARE/docs/providers/CDI/IVC-CDI-00030.pdf - FDA Warning on Compounded Ketamine Risks
https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine
