Anxiety disorders and post-traumatic stress disorder (PTSD) can affect daily functioning, relationships, sleep, and quality of life. Anxiety symptoms may interfere with work, school, social situations, and routine activities, especially when they become persistent or difficult to manage (National Institute of Mental Health, n.d.).
Many people try multiple medications and psychotherapeutic approaches over the course of years and still carry a daily burden of symptoms. For those patients, it can be important to discuss whether additional treatment options may be appropriate.
At Initia Nova in Wilmington, we offer ketamine infusion therapy and Ketamine-Assisted Psychotherapy (KAP). We begin with a careful evaluation of each patient’s history, symptoms, prior treatment experiences, goals, and safety considerations before recommending any path forward.
The Neuroscience of Anxiety and Trauma
How Anxiety Becomes Entrenched
Anxiety disorders can involve persistent fear, avoidance, physical tension, racing thoughts, and heightened alertness. Research has examined the role of brain networks involved in threat detection, memory, and emotional regulation, including the amygdala, prefrontal cortex, and hippocampus.
However, anxiety is not explained by one brain region or one biological pathway. Each person’s symptoms, history, and treatment needs are different. Before considering any treatment approach, including ketamine therapy, we encourage patients to discuss their full psychiatric and medical history with a qualified provider.
PTSD: When Trauma Remains Present
PTSD can develop after a traumatic event and may include intrusive memories, nightmares, avoidance, changes in mood or thinking, sleep disruption, and heightened reactivity. Symptoms may interfere with relationships, work, and everyday life long after the immediate danger has passed (VA National Center for PTSD, n.d.).
Trauma-focused psychotherapies, including Prolonged Exposure, Cognitive Processing Therapy, and Eye Movement Desensitization and Reprocessing, have some of the strongest evidence for PTSD treatment. Medication may also be appropriate for some patients, depending on their needs and preferences (VA National Center for PTSD, n.d.).
For patients who continue to struggle despite prior care, we may discuss whether ketamine therapy could be considered within a broader treatment plan. If you want to learn more about what the symptoms of PTSD look like, our resource library covers these in detail.
The Role of the Glutamate System
Ketamine works differently from many traditional psychiatric medications. It acts on NMDA receptors in the brain’s glutamate system, and researchers continue to study the downstream effects that may involve synaptic signaling and neuroplasticity (Zanos & Gould, 2018).
This mechanism has led researchers to study ketamine across several psychiatric conditions. Still, the biological effects of ketamine do not predict an individual patient’s outcome. Ketamine is FDA-approved as an anesthetic, while its use for anxiety and PTSD is off-label (Sanacora et al., 2017).
Ketamine for Anxiety: The Emerging Evidence
Clinical Research on Anxiety Disorders
The evidence base for ketamine in anxiety disorders is still developing. A systematic review and meta-analysis of randomized trials found preliminary evidence that acute ketamine may reduce symptoms in some treatment-resistant anxiety spectrum disorders, while also noting the limited number of studies and the need for stronger long-term research (Whittaker et al., 2021).
This means ketamine therapy should not be viewed as a universal solution for anxiety. Some patients may experience meaningful symptom improvement, while others may experience more gradual changes or may not respond. Individual results vary.
At Initia Nova, we evaluate factors such as diagnosis, symptom severity, prior treatment history, current medications, and co-occurring conditions before recommending a treatment path. To understand what conditions we treat more broadly, visit our page on anxiety treatment with ketamine.
Anxiety and the Integration Window
Some clinicians use the term “integration” to describe the reflection and therapeutic work that can take place before and after treatment. KAP combines ketamine treatment with psychotherapy for patients who may benefit from a more structured, therapy-centered approach.
We do not assume that KAP is appropriate for every person with anxiety. We discuss the potential role of therapy, preparation, and follow-up based on each patient’s goals and clinical history.
Ketamine for PTSD: A Rapidly Evolving Field
The Evidence Base
Research on ketamine for PTSD has expanded in recent years. One randomized controlled trial of repeated ketamine infusions found greater reductions in PTSD symptom severity among participants with chronic PTSD compared with an active placebo group (Feder et al., 2021).
At the same time, the overall evidence remains mixed. The 2023 VA/DoD Clinical Practice Guideline recommends against ketamine for PTSD because it found insufficient evidence of clear net benefit relative to potential harms (Department of Veterans Affairs & Department of Defense [VA/DoD], 2023).
For that reason, we do not present ketamine as a replacement for trauma-focused psychotherapy or as a guaranteed answer to PTSD. We review the available evidence, uncertainty, potential risks, and each patient’s treatment history before determining whether ketamine therapy may be appropriate.
KAP and Trauma Integration
For some patients with PTSD, KAP may provide an opportunity to combine ketamine treatment with psychotherapy in a coordinated setting. We may discuss KAP for patients who want to explore whether this structured model fits within their broader treatment plan.
Trauma treatment is highly individual. We work to ensure that any recommended approach reflects the patient’s history, needs, level of readiness, and existing care plan. Our blog post on ketamine infusion therapy for depression, anxiety, and PTSD provides additional context on how these treatments are applied.
Co-Occurring Conditions
Anxiety disorders and PTSD can occur alongside depression, substance use concerns, and other mental health conditions. These co-occurring symptoms can make treatment more complex and reinforce the importance of a comprehensive evaluation.
At Initia Nova, we look beyond a single diagnosis. We consider the full clinical picture before recommending ketamine infusion therapy, KAP, medication management, psychotherapy, or another appropriate next step.
What to Expect at Initia Nova Wilmington
The Evaluation Process
Before treatment begins, we complete a thorough evaluation that includes psychiatric history, medical history, current medications, prior treatment experiences, symptom patterns, and safety considerations.
We encourage patients to be open about trauma history, substance use history, dissociation, psychosis, cardiovascular concerns, and any other factors that could affect treatment planning. This helps us determine whether ketamine therapy is appropriate and how care should be structured.
Patients considering treatment can also review our guide on choosing a ketamine infusion clinic before scheduling an evaluation.
During Treatment
Ketamine infusion sessions take place in a calm, monitored clinical setting. We monitor vital signs during treatment and remain available to address questions or concerns throughout the visit.
Some patients experience temporary perceptual changes, dissociation, dizziness, nausea, or changes in blood pressure during an infusion. These effects are typically monitored closely and often resolve as treatment concludes (Short et al., 2018).
We review transportation, recovery expectations, and individualized post-treatment guidance before each patient begins care. Patients can also learn more about what to expect from ketamine infusion therapy and review our ketamine infusion therapy FAQs.
Parting Thoughts
Anxiety and PTSD can create a heavy and lasting burden. While conventional treatment helps many people, some continue to search for an approach that feels better aligned with their needs.
At Initia Nova, we believe patients deserve thoughtful evaluation, honest conversations about the evidence, and individualized care. Ketamine therapy may be an option for some patients with anxiety or PTSD, but it should always be considered within the context of a full psychiatric and medical assessment.
For patients in Wilmington and the surrounding Delaware region, we invite you to learn more about how to get ketamine treatment or visit our Wilmington office page. To take the next step, schedule a consultation with our team. We are available to answer questions, provide evaluations, and discuss whether ketamine infusion therapy or KAP may be appropriate for your situation. Call us at (302) 599-6286 to begin the conversation.
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy, TMS, SPRAVATO®, and other treatments described should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.
References
Department of Veterans Affairs & Department of Defense. (2023). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. U.S. Department of Veterans Affairs.
Feder, A., Costi, S., Rutter, S. B., Collins, A. B., Govindarajulu, U., Jha, M. K., Horn, S. R., Kautz, M., Corniquel, M., Collins, K. A., Bevilacqua, L., Glasgow, A. M., Brallier, J., Pietrzak, R. H., Murrough, J. W., & Charney, D. S. (2021). A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. American Journal of Psychiatry, 178(2), 193-202. DOI: 10.1176/appi.ajp.2020.20050596
National Institute of Mental Health. (n.d.). Anxiety disorders. National Institutes of Health.
Sanacora, G., Frye, M. A., McDonald, W., Mathew, S. J., Turner, M. S., Schatzberg, A. F., Summergrad, P., & Nemeroff, C. B. (2017). A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry, 74(4), 399-405. DOI: 10.1001/jamapsychiatry.2017.0080
Short, B., Fong, J., Galvez, V., Shelker, W., & Loo, C. K. (2018). Side-effects associated with ketamine use in depression: A systematic review. The Lancet Psychiatry, 5(1), 65-78. DOI: 10.1016/S2215-0366(17)30272-9
VA National Center for PTSD. (n.d.). Overview of psychotherapy for PTSD. U.S. Department of Veterans Affairs.
Whittaker, E., Dadabayev, A. R., Joshi, S. A., & Glue, P. (2021). Systematic review and meta-analysis of randomized controlled trials of ketamine in the treatment of refractory anxiety spectrum disorders. Therapeutic Advances in Psychopharmacology, 11, 20451253211056743. DOI: 10.1177/20451253211056743
Zanos, P., & Gould, T. D. (2018). Mechanisms of ketamine action as an antidepressant. Molecular Psychiatry, 23(4), 801-811. DOI: 10.1038/mp.2017.255