Resolution of Panic Disorder, Agoraphobia, and Anxiety with Ketamine: A Case Report

Imagine living a life filled with anxiety and panic attacks so severe that you are not even able to leave your house. In a 2016 case report from the Department of Psychiatry at the University of Utah, they share the story of Ms. A, a 34 year old woman who had been diagnosed with DSM-5 panic disorder, agoraphobia, generalized anxiety disorder (GAD) and major depressive disorder.

She had experienced long-term anxiety and panic attacks that left her homebound. She was unable to learn how to drive and didn’t feel comfortable leaving home, shopping or using transportation by herself. She also worried about causing harm or distress to people close to her.

Her depression and anxiety was initially treated using a combination of electroconvulsive therapy (ECT), escitalopram up to 30 mg, lamotrigine up to 400 mg, lorazepam and cognitive-behavioral therapy (CBT). Even though her depression improved and her suicidal ideation decreased, there was no marked improvement in her anxiety.

Ms. A went to the emergency department for severe neck pain caused by two herniated discs. The physician administered Ms. A with a single infusion of 34 mg of ketamine (0.5 mg/kg) to help alleviate her pain. Four days before this infusion, she had scored an 8 on the Patient Health Questionnaire and a 6 on the Generalized Anxiety Disorder scale. Immediately after the infusion, she had a marked decrease in anxiety and her scores fell to 3 and 1 on the questionnaires.

Ms. A experienced a major improvement in her anxiety for ten weeks following the infusion, and continued to remain free of panic attacks. She gained more confidence and was able to do a wide variety of things independently, such as starting a business with a friend. Ms. A improved so much that maintenance ECT was no longer needed.

Because her response to other treatments was so minimal, and her response to the of ketamine itself was so powerful, it is believed that she experienced remission from panic disorder, agoraphobia, and generalized anxiety disorder due to ketamine.

Serendipitously, the emergency physician chose to use ketamine for the treatment of pain, which resulted in a significant improvement for Ms. A’s psychological health. However, it’s important to know that results are variable and that this case report is just one story of the positive-life changing effect from ketamine.

Reference:

Ray, S. M., & Kious, B. M. (2016). Sustained Resolution of Panic Disorder, Agoraphobia, and Generalized Anxiety Disorder With a Single Ketamine Infusion. The Primary Care Companion For CNS Disorders. doi:10.4088/pcc.15l01899

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