Ketamine Therapy for Anxiety Co-occurring with Depression
When Depression and Anxiety Arrive Together, We Treat Both
When Depression and Anxiety Overlap
Depression and anxiety rarely travel alone. When they occur together, symptom burden is higher and treatment is often harder. Ketamine’s effects on depression can significantly relieve co-occurring anxiety — often within the same treatment course.
The co-occurrence of depression and anxiety is not the exception — it’s the rule. Research consistently shows that more than 50% of patients with major depressive disorder also meet criteria for at least one anxiety disorder. Generalized anxiety disorder, panic disorder, social anxiety, and health anxiety are among the most common companions to depression.
When both conditions are present simultaneously, treatment outcomes are generally worse with standard approaches: antidepressants that take weeks to work leave patients in a window of vulnerability; CBT requires sustained engagement that severe symptoms can make difficult; and side effects are often amplified. The result is that patients with comorbid anxiety-depression frequently remain undertreated and disproportionately disabled.
“Treatment-resistant anxiety causes damage in the neuronal connections of the hippocampus and the prefrontal cortex. Ketamine’s downstream effects increase neural plasticity and growth which may help reverse some of these changes.”
— Dr. Raquel Bennett, ADAA, 2023
The shared neurobiology between anxiety and depression — including disrupted glutamatergic signaling, prefrontal cortex dysregulation, and hippocampal changes — is precisely where ketamine exerts its most potent effects.
What the Research Shows
A major real-world retrospective analysis published in the Journal of Affective Disorders (2023) examined 714 patients across 10 U.S. ketamine infusion clinics. The study found significant and concurrent reduction in both anxiety and depression symptoms following an IV ketamine induction series, with a large effect size for anxiety (Cohen’s d = -1.17) and an even larger effect size for depression (Cohen’s d = -1.56). Symptom improvements remained stable at up to one year of follow-up.
A systematic review in Neuropsychopharmacology of refractory anxiety studies found that ketamine consistently produced acute but transient anxiolytic effects. A separate open-label study found that anxiety was significantly reduced by day 3 of treatment, with improvements maintained through 28 days.
50%+
Of patients with major depression also have a diagnosable anxiety disorder
Day 3
Anxiety reduction observed by day 3 of ketamine treatment in open-label study
1 year
Follow-up period over which symptom relief was maintained in real-world ketamine clinic data
Yale Medicine researchers describe ketamine’s mechanism as fundamentally different from conventional anxiolytics like benzodiazepines: rather than providing temporary relief that ends when the drug leaves the system, ketamine “triggers reactions in your cortex that enable brain connections to regrow” — producing effects that persist beyond the drug’s presence in the body. This neuroplastic effect may be particularly meaningful for patients whose anxiety has a strong cognitive component.
Our Approach to Anxiety and Depression Together
We do not treat anxiety in isolation from depression. When both are present, we focus our clinical attention on the depressive disorder as the primary target, with the understanding that anxiety symptoms frequently co-improve as the depression responds to treatment.
Conditions we address in this category
• Major depressive disorder with generalized anxiety disorder (GAD)
• Depression with panic disorder
• Depression with social anxiety
• Anxious depression (depression with prominent anxious distress specifier)
• Depression with health anxiety or illness anxiety disorder
• Treatment-resistant presentations of comorbid depression and anxiety
Combined treatment approach: Ketamine works best as part of a comprehensive treatment plan. We encourage patients with significant anxiety to maintain or establish psychotherapy — particularly CBT — alongside ketamine, as research suggests ketamine may enhance the neuroplastic conditions in which therapeutic work is most productive.