Social anxiety disorder (SAD) is a notoriously hard nut for mental health practitioners to crack, with many sufferers left battling the symptoms despite regular cognitive behavioural therapy and selective serotonin reuptake inhibitors (SSRIs).
So researchers are understandably excited by the idea that ketamine (ketamine hydrochloride), the anaesthetic and club drug known to induce a trance-like state, could significantly ease the anguish felt by those with SAD.
One of the latest findings along these lines was recently published in the journal Neuropsychopharmacology. For their study, researchers tested the effects of intravenous ketamine on 18 adults with SAD. Not only did participants find that ketamine alleviated their symptoms, they also reported increased social engagement in the days following (although this effect was not tracked by researchers).
"This study suggests that medications that act similarly to ketamine, which are currently being designed and/or tested for the treatment of major depression, may also be effective in treating anxiety that is also a major health problem and a source of impairment for many patients," Dr. Michael Bloch, the study's co-author, told VICE.
Bloch, a psychiatrist affiliated with Yale-New Haven Hospital, said these future medications will also hopefully be delivered in a way that's easy to administer and more tolerable for patients, especially when it comes to long term use. This could be by mouth, intranasally, or through a skin patch.
They would also, ideally, have less extreme side effects similar in nature to psychosis, such as dissociation and euphoria, which would in turn reduce the drug's vulnerability to abuse.
Ketamine works on a totally different type of neurotransmitter system than current antidepressants, and it's not the first time researchers have tested its effect on anxiety, but this trial is significant for a few key reasons.
First, rather than having the participants self-report, researchers measured symptoms using the Liebowitz Social Anxiety Scale, created in 1987 to objectively assess "the way that social phobia plays a role in your life across a variety of situations." Secondly, this is the first placebo-controlled study on ketamine's effect on anxiety, the placebo being normal saline. (A 2017 study on 12 adults with general anxiety disorder or SAD found ketamine reduced their symptoms, but the study wasn't placebo-controlled.)
But before ketamine is bundled into pill or spray form, the drug first used as an anesthesia medicine in the Vietnam War needs more closely controlled trials, Bloch said. And even if it did prove effective and feasible, it should be reserved for debilitating cases that weren't responsive to medication and CBT. For example, if someone felt too anxious to leave their own home.
Studies like this also have their limitations: they don't provide data on the long-term safety or efficacy of ketamine, only that it works once. And, as Bloch points out, it's hard to maintain a placebo distinction after the infusion; in other words, you'll soon know if you've been given ketamine rather than saline.
As companies develop ketamine-like compounds which could hit the market for depression in a matter of just a few years, the drug's use for anxiety disorders like SAD would need even more research. That's because most trials so far have focused on ketamine's effect on major depression, and the two don't always go hand-in-hand.
Meantime, in the US, so-called ketamine clinics already offer the drug off-label for depression, although experts warn there isn't enough longterm safety data or regulatory protocol to make this safe.
Ketamine isn't approved for use in Australia for mental disorders, but it does have Therapeutic Goods Administration (TGA) approval as an anaesthetic. Trials are underway to assess when and if it will be widely adopted as a clinical treatment for depression.