Anxiety can affect nearly every part of daily life. It may keep your mind moving long after you want to rest, create physical tension that never fully releases, or gradually narrow your world through avoidance.
Medication helps many people. So do cognitive behavioral therapy, exposure-based treatment, and other established approaches. But some adults continue to experience significant symptoms after trying conventional care—or find that a treatment helps only partially, causes difficult side effects, or does not address the full clinical picture.
At Mend The Mind in Livingston, Montana, we do not assume that persistent anxiety automatically calls for a newer treatment. We begin by understanding which kind of anxiety you are experiencing, what you have already tried, whether those treatments were adequate, and whether another condition may be contributing.
For carefully selected adults whose symptoms have remained severe despite appropriate care, off-label ketamine may become part of that discussion. The evidence is still developing, and anxiety alone does not determine candidacy.
Anxiety Is More Than Ordinary Worry
Some anxiety is part of being human. It can sharpen attention, alert us to danger, and help us prepare for something important.
An anxiety disorder is different. Fear, worry, or physical arousal becomes persistent, difficult to control, disproportionate to the situation, or disruptive enough to interfere with work, relationships, sleep, health, and ordinary responsibilities.
Anxiety disorders are not one uniform condition. They include:
- Generalized anxiety disorder, which involves excessive and difficult-to-control worry across multiple areas of life
- Panic disorder, which involves recurring unexpected panic attacks and concern or avoidance related to future attacks
- Social anxiety disorder, which centers on fear of scrutiny, embarrassment, rejection, or negative judgment
- Specific phobias, which involve intense fear and avoidance linked to a particular object or situation
- Agoraphobia, which involves fear and avoidance of settings where escape or help may feel difficult
Each condition has its own patterns and evidence-based treatments. A strategy that is effective for generalized worry may not fully address panic, a phobia, or social avoidance.
That is why we avoid treating “anxiety” as a single symptom with a single solution. Our anxiety treatment overview explains more about the presentations we evaluate in Livingston.
Anxiety Can Affect the Body as Much as the Mind
Anxiety is often described as worry, but many people first notice it physically.
You may experience:
- Muscle tension or jaw clenching
- A racing or pounding heart
- Shortness of breath
- Sweating or trembling
- Nausea or digestive distress
- Dizziness or lightheadedness
- Restlessness
- Difficulty sleeping
- Fatigue from remaining constantly alert
- Trouble concentrating when your attention is pulled toward possible threats
These symptoms are real. They do not mean you are weak, dramatic, or failing to control your thoughts.
They also are not specific to anxiety. Thyroid disorders, heart rhythm problems, sleep disruption, medication effects, stimulant use, substance withdrawal, chronic pain, trauma, and other medical or psychiatric conditions can produce overlapping symptoms.
A careful evaluation should consider those possibilities rather than assuming that every racing heart, sleepless night, or period of agitation has the same cause.
Why Medication May Help Without Being Enough
SSRIs and SNRIs are commonly used to treat several anxiety disorders. Other medications may be considered depending on the diagnosis, symptoms, co-occurring conditions, and individual risks.
These treatments can be highly effective. They may reduce the intensity of worry, panic, physical arousal, or avoidance enough for someone to function more comfortably and participate more fully in therapy.
Medication can also fall short for several reasons:
- The medication was not the right fit for the specific anxiety disorder.
- The dose was not therapeutic.
- The trial ended before there was enough time to assess the effect.
- Side effects prevented continued use.
- Symptoms improved only partially.
- The anxiety is being maintained by avoidance that medication alone cannot change.
- Depression, trauma, bipolar disorder, substance use, insomnia, or another condition is also present.
- A medical problem is contributing to the symptoms.
- The diagnosis needs to be reconsidered.
We do not view an incomplete response as a personal failure. We also do not assume that trying more medications is automatically the answer.
The useful question is what the previous treatment taught us. Did it reduce physical symptoms but leave avoidance unchanged? Did it help worry but cause intolerable fatigue? Was psychotherapy included? Did symptoms return during a major stressor, or were they never adequately controlled?
Those details guide the next conversation.
Therapy Often Addresses What Medication Cannot
Medication may reduce the intensity of anxiety, but it does not always change the beliefs, behaviors, and avoidance patterns that keep anxiety active.
Cognitive behavioral therapy helps identify the relationship among thoughts, emotions, physical sensations, and actions. Exposure-based approaches help people gradually face feared situations or sensations without relying on avoidance or safety behaviors.
This matters because avoidance usually works in the short term. Leaving a crowded store, declining a social invitation, repeatedly seeking reassurance, or avoiding a feared sensation may reduce anxiety for the moment.
That immediate relief can teach the brain that avoidance was necessary. Over time, the range of situations that feel safe may become smaller.
Effective therapy does not mean forcing yourself into the most frightening situation without preparation. It involves planned, gradual work at a level you can tolerate, usually with support from a clinician who understands the specific disorder.
When medication has not been enough, we want to know whether you have had access to evidence-based psychotherapy, what type of therapy you received, and whether the treatment addressed the mechanisms maintaining your symptoms.
“Treatment-Resistant Anxiety” Is Not One Precise Category
The phrase “treatment-resistant anxiety” is used clinically and in research, but there is no single definition accepted across every anxiety disorder.
In general, it describes significant symptoms that continue despite adequate evidence-based treatment. But what counts as an adequate trial depends on the diagnosis, the medication, the dose, the duration, the type of psychotherapy, and whether the person could participate consistently.
Before describing anxiety as resistant, it is reasonable to ask:
- Has the diagnosis been clearly established?
- Were medication trials long enough and appropriately dosed?
- Were side effects or adherence problems documented?
- Was evidence-based psychotherapy attempted?
- Did the therapy include exposure when appropriate?
- Are depression, PTSD, OCD, bipolar disorder, substance use, or sleep problems complicating the presentation?
- Could a medical condition or another medication be contributing?
- Is the person still living within an active threat or unstable environment?
Sometimes the review reveals that a conventional option has not yet been fully explored. Sometimes it confirms that several appropriate treatments have produced little relief.
At Mend The Mind, that distinction is central to how we evaluate ketamine candidacy. We want to give you an honest assessment rather than a default yes.
Where IV Ketamine May Fit
For selected adults with severe, persistent anxiety that has not responded adequately to established treatments, off-label IV ketamine therapy may be considered.
Ketamine affects glutamate signaling, including activity involving NMDA receptors. Researchers believe its psychiatric effects may involve downstream changes in synaptic communication and plasticity, although the full mechanism is not completely understood.
This differs from the primary mechanisms of SSRIs and SNRIs. That difference has led researchers to study ketamine in people with refractory anxiety disorders and in people experiencing anxiety alongside depression or other psychiatric conditions.
Small trials and systematic reviews have reported rapid anxiety reductions in some participants. Research has included social anxiety disorder and treatment-refractory generalized and social anxiety, among other anxiety-related presentations.
The findings are encouraging enough to justify continued research, but the evidence has important limits:
- Many studies have enrolled small numbers of participants.
- Different studies have included different diagnoses.
- Doses, routes, schedules, comparison treatments, and outcome measures vary.
- Some reported effects were short-lived.
- Longer-term effectiveness and repeated-treatment strategies remain uncertain.
- Results from one anxiety disorder cannot automatically be applied to every other anxiety presentation.
IV ketamine for anxiety is off-label. It is not FDA-approved for anxiety disorders, and it is not a first-line treatment.
We view the current evidence as a reason for careful evaluation—not as proof that ketamine will work for everyone whose anxiety has persisted.
Our complete guide to IV ketamine therapy explains more about the treatment setting, medical monitoring, and practical preparation involved.
Rapid Change Is Not the Same as Lasting Recovery
The possibility of relatively rapid symptom relief is one reason ketamine receives attention.
For someone who has spent months or years managing constant worry, panic, or avoidance, even a temporary reduction may feel significant. It may create space to sleep, think more clearly, reconnect with daily activities, or participate more fully in psychotherapy.
But an early change does not tell us how long the benefit will last.
A meaningful treatment plan asks more than whether anxiety scores decreased shortly after an infusion. We also want to understand whether you are:
- Sleeping more consistently
- Returning to activities you have avoided
- Participating more fully in therapy
- Functioning better at work or home
- Experiencing fewer or less severe panic episodes
- Relying less on reassurance or safety behaviors
- Feeling more able to tolerate uncertainty
- Maintaining improvement between treatments
Ketamine does not remove every source of fear, change an unsafe environment, or teach exposure skills by itself. Any symptom relief should be considered within a broader plan that addresses the behaviors, circumstances, and co-occurring conditions connected to the anxiety.
Results vary. Some people may experience meaningful benefit, some a partial response, and others little or no improvement.
Research on how ketamine may support neuroplasticity and ketamine healing sheds light on why some patients experience more durable gains when treatment is paired with ongoing therapeutic work.
What We Review Before Recommending Treatment
An anxiety diagnosis alone does not establish that ketamine is safe or appropriate.
Our evaluation may include:
- The specific anxiety symptoms and diagnoses involved
- When the symptoms began and how they have changed
- The situations, sensations, or thoughts that trigger anxiety
- The degree of avoidance and functional impairment
- Previous medication trials, including dose, duration, benefit, and side effects
- Previous psychotherapy and whether it included an evidence-based approach
- Current medications and prescribing providers
- Depression, trauma, OCD symptoms, mania, hypomania, psychosis, or dissociation
- Sleep quality and possible sleep disorders
- Substance-use history
- Medical conditions that may mimic or worsen anxiety
- Cardiovascular health and blood-pressure control
- Current safety concerns
- Transportation and support after treatment
We also want to understand what you hope will change.
“Eliminate all anxiety” is not usually a realistic or even desirable goal. Anxiety has a protective purpose. A more useful goal may be reducing symptoms enough that you can sleep, work, enter social situations, drive, travel, participate in therapy, or make decisions without fear determining every step.
When ketamine is unlikely to address the central problem—or when another evaluation should come first—we will explain that directly.
Medical Monitoring Matters
Ketamine can temporarily affect blood pressure, heart rate, alertness, coordination, perception, and emotional state.
Possible experiences during or after treatment may include dissociation, dizziness, nausea, sedation, anxiety, changes in perception, or a temporary increase in blood pressure or heart rate.
For a person who is already sensitive to physical signs of anxiety, those sensations may feel unsettling. Preparation matters. We discuss what you may experience, how we monitor you, and how to communicate discomfort during an infusion.
At Mend The Mind, IV treatment takes place in our Livingston clinic with medical oversight and vital-sign monitoring. You must arrange for a responsible adult to drive you home, and you should follow the individualized post-treatment instructions you receive.
Ketamine is not appropriate for every medical or psychiatric history. Screening is part of the treatment—not a formality before it.
If you want to know what to expect step by step, our guide on what to expect at your first ketamine infusion walks through the process in detail.
Where Ketamine Troches May Fit
Ketamine troches are compounded lozenges that dissolve in the mouth and may be used at home under medical direction.
For selected patients, we may consider them as maintenance between clinic visits, after a response to IV treatment, or as another carefully supervised option when the individual circumstances support it.
Troches are not interchangeable with IV infusions. Their absorption is more variable, the treatment setting is less controlled, and the evidence for at-home troches in anxiety disorders is less developed than the evidence for IV ketamine.
Appropriate use requires:
- A full clinical evaluation
- Individualized prescribing
- A safe and stable treatment environment
- Clear preparation and recovery instructions
- Responsible adherence to the prescribed dose
- Restrictions on driving and other activities
- Ongoing follow-up
- Honest reporting of benefits, side effects, and use
We do not view troches as a casual solution for an anxious day or as a substitute for psychotherapy. They are a prescription treatment that requires an ongoing clinical relationship.
Our article on how we use ketamine troches in Montana explains the differences between at-home and clinic-based treatment in more detail.
Distance Can Make an Already Difficult Process Harder
Living with anxiety in rural Montana can involve an additional layer of planning.
Finding a therapist with experience treating a specific anxiety disorder may require travel or telehealth. Psychiatric appointments may be difficult to schedule. Transportation, winter weather, work responsibilities, caregiving, and reliable internet access can all affect whether a treatment is realistically available.
Those barriers do not mean that specialized care should be offered without the same screening and safeguards used elsewhere. They mean the logistics should be discussed clearly before you commit.
Ketamine treatment requires more than arriving for an appointment. You need transportation after an infusion, time to recover, and the ability to attend follow-up care. If you live outside Livingston, we consider the travel burden as part of candidacy and planning.
Our article about accessing ketamine therapy in rural Montana discusses those practical concerns more fully.
We Take Anxiety Seriously Without Promising a Shortcut
Anxiety can be invisible to everyone except the person experiencing it.
You may continue working, caring for family, or showing up socially while your body remains tense and your thoughts remain fixed on what could go wrong. You may also have been told that you are overthinking, need to relax, or should simply push through.
We take the impairment seriously.
We also believe respect includes honesty. We will not describe ketamine as a cure for anxiety. We will not assume that a different medication mechanism can replace skilled therapy. We will not promise that an infusion will undo years of avoidance or permanently eliminate uncertainty.
Our role is to understand your history, explain what the research supports, identify the limitations, and determine whether what we offer has a reasonable place in your care.
Questions We Hear About Anxiety and Ketamine
What does it mean when medication is not enough?
It may mean that medication reduced some symptoms but left significant worry, panic, physical arousal, or avoidance. It may also mean side effects limited treatment, the medication was not the right fit, another condition is present, or psychotherapy is needed to address patterns medication cannot change by itself.
Before moving to another treatment, your care team should consider the diagnosis, dose, duration, response, side effects, therapy history, medical factors, and co-occurring symptoms.
How many treatments must fail before anxiety is considered resistant?
There is no single definition that applies to every anxiety disorder.
Researchers and clinicians generally use the term when substantial symptoms persist despite adequate evidence-based treatment. What qualifies as adequate depends on the diagnosis and the treatments attempted.
A careful review is more useful than relying on a fixed number alone.
Can ketamine help anxiety without depression?
Some small studies have evaluated ketamine in people with refractory generalized or social anxiety who were not currently depressed, and some participants experienced rapid symptom reductions.
The research remains limited, however. Evidence from people with anxiety symptoms during depression cannot automatically be applied to a primary anxiety disorder.
Whether ketamine is appropriate depends on your diagnosis, history, previous treatment, medical risks, and current clinical presentation.
Is ketamine approved for anxiety?
No. IV ketamine used for anxiety disorders is an off-label treatment.
Off-label prescribing is a recognized part of medical practice, but it does not mean that the treatment has been proven for every anxiety condition. The evidence, risks, alternatives, and uncertainty should be discussed before you decide whether to proceed.
Does ketamine replace therapy?
No.
Anxiety is often maintained by avoidance, reassurance seeking, fear of physical sensations, rigid threat predictions, or other patterns that require behavioral and psychological work. Ketamine may reduce symptoms for some people, but it does not teach those skills by itself.
When psychotherapy is appropriate, we encourage you to continue working with a qualified therapist.
How do we decide between IV ketamine and troches?
We consider your prior response to ketamine, symptom severity, medical and psychiatric history, treatment goals, home environment, ability to follow safety instructions, travel constraints, and need for clinical monitoring.
IV treatment offers precise administration and direct monitoring. Troches offer greater flexibility but have more variable absorption and require greater responsibility at home.
Neither route is automatically right for every patient.
What should I do if anxiety feels like an emergency?
Seek urgent help if you cannot keep yourself safe, are considering suicide or self-harm, are experiencing severe confusion or psychosis, or believe a physical symptom may represent a medical emergency.
Call or text 988, call 911, or go to the nearest emergency department. An outpatient ketamine consultation is not a substitute for crisis or emergency care.
What We Want You to Remember
- Anxiety disorders involve more than ordinary worry and can significantly affect physical health, relationships, work, sleep, and daily functioning.
- Different anxiety disorders require different treatment strategies.
- Medication helps many people, but partial response does not mean you have failed.
- Evidence-based psychotherapy remains central to anxiety treatment, particularly when avoidance is maintaining symptoms.
- “Treatment-resistant anxiety” does not have one universally accepted definition.
- IV ketamine for anxiety is off-label and is not a first-line treatment.
- Early studies suggest possible rapid benefit for some carefully selected patients, but the evidence remains limited and varies by diagnosis.
- Ketamine troches require individualized prescribing, a safe home setting, and ongoing clinical oversight.
- A complete assessment should come before any recommendation.
- Results vary, and no outcome is guaranteed.
An Honest Next Step in Livingston
When anxiety continues despite medication, the answer is not always another prescription—and it is not automatically ketamine.
The next useful step is understanding what has and has not been addressed. That includes the specific anxiety disorder, the adequacy of previous treatment, access to evidence-based therapy, medical contributors, co-occurring conditions, and the degree to which symptoms are limiting your life.
At Mend The Mind, we evaluate whether off-label ketamine may have a responsible role when established care has not provided enough relief. We approach that decision carefully because the anxiety-specific evidence is promising but still limited.
When ketamine is not a reasonable fit, we will tell you. When it may be worth considering, we will explain the possible benefits, uncertainties, risks, medical requirements, and practical commitment involved.
Results vary, and no outcome is guaranteed. When you are ready to discuss whether a ketamine evaluation makes sense for your situation, you can request a consultation with our Livingston clinic.
If you would like to get started now, schedule a consultation with our team at Mend The Mind.
About Cassidy Boyer, CRNA
Cassidy Boyer, CRNA, founded Mend The Mind in Livingston, Montana. She is a board-certified Certified Registered Nurse Anesthesiologist, a Montana native, and a U.S. Air Force veteran with more than a decade of clinical experience using ketamine in monitored medical settings.
Cassidy is currently completing post-master’s Psychiatric-Mental Health Nurse Practitioner training through Montana State University. At Mend The Mind, we combine anesthesia-informed medical oversight with a trauma-informed, whole-person approach to ketamine evaluation and treatment.
Every recommendation begins with a detailed review of your medical history, psychiatric history, current medications, previous treatment, individual risks, practical circumstances, and goals.
Works Cited
Glue, P., Neehoff, S., Sabadel, A., Broughton, L., Le Nedelec, M., Shadli, S., McNaughton, N., & Medlicott, N. J. (2020). Effects of ketamine in patients with treatment-refractory generalized anxiety and social anxiety disorders: Exploratory double-blind psychoactive-controlled replication study. Journal of Psychopharmacology, 34(3), 267–272.
National Institute of Mental Health. (n.d.). Anxiety disorders. National Institutes of Health. Retrieved July 15, 2026.
Taylor, J. H., Landeros-Weisenberger, A., Coughlin, C., Mulqueen, J., Johnson, J. A., Gabriel, D., Reed, M. O., Jakubovski, E., & Bloch, M. H. (2018). Ketamine for social anxiety disorder: A randomized, placebo-controlled crossover trial. Neuropsychopharmacology, 43(2), 325–333.
Tully, J. L., Dahlén, A. D., Haggarty, C. J., Schiöth, H. B., & Brooks, S. (2022). Ketamine treatment for refractory anxiety: A systematic review. British Journal of Clinical Pharmacology, 88(10), 4412–4426.
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.
World Health Organization. (2025, September 8). Anxiety disorders.
Medical Disclaimer
This content is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not intended to replace care from a qualified healthcare professional familiar with your medical and psychiatric history.
IV ketamine and ketamine troches used for anxiety and other psychiatric conditions are off-label treatments. Individual results vary, and no outcome is guaranteed. Do not begin, stop, or change a psychiatric medication without consulting the clinician responsible for prescribing it.
If you are experiencing a mental health crisis or thoughts of suicide or self-harm, call or text 988 to reach the Suicide & Crisis Lifeline, call 911, or go to the nearest emergency department.