Panic disorder affects approximately 4.7 percent of adults in the United States at some point in their lives, and for a meaningful subset of those individuals, first-line treatments—SSRIs, benzodiazepines, and cognitive behavioral therapy—provide incomplete relief even after years of diligent engagement. The experience of a panic attack is so physiologically consuming that the anticipatory anxiety alone can begin to restructure daily life around avoidance, eventually producing agoraphobia and a world that shrinks month by month. At OC Ketamine Therapy in Newport Beach, we want to explore what the current research suggests about IV ketamine as an off-label option for patients with panic disorder who have not found adequate relief through conventional care. (National Institute of Mental Health [NIMH], n.d.-a)
Understanding Panic Disorder
A panic attack is a discrete episode of intense fear or discomfort that can peak within minutes and may include physical symptoms such as a pounding heart, shortness of breath, chest tightness, dizziness, sweating, trembling, nausea, numbness, or a sense of unreality. The experience is not simply intense anxiety; it can feel indistinguishable from a cardiac emergency, and many people with panic disorder seek urgent medical care before receiving an accurate diagnosis. The disorder itself involves recurrent, unexpected panic attacks followed by persistent worry about future attacks and behavioral changes aimed at preventing them. (NIMH, n.d.-b)
The neurobiology of panic involves several overlapping systems. The amygdala—the brain’s threat-detection hub—plays a central role, along with brain regions involved in autonomic arousal and prefrontal regulation of fear responses. In panic disorder, the alarm system may activate even in the absence of genuine threat. The neural loop can become self-reinforcing: the memory of panic produces anticipatory fear, which activates the alarm system, which produces more panic. (Sobanski & Wagner, 2017)
Standard treatments target this system in distinct ways. SSRIs and SNRIs can reduce panic symptoms over weeks of daily dosing. Benzodiazepines can provide acute relief but may carry risks of tolerance, dependence, cognitive side effects, and rebound anxiety. Cognitive behavioral therapy, particularly panic-focused CBT, teaches patients to interrupt catastrophic interpretations of physical sensations and engage in graduated exposure to feared sensations through interoceptive exposure exercises. For many patients, this combination is effective. For others, the severity of anxiety prevents meaningful engagement with therapy, or pharmacological options have been exhausted or are contraindicated. (Garakani et al., 2020; NIMH, n.d.-b)
Why Ketamine Is Being Studied for Panic Disorder
The case for IV ketamine in panic disorder begins with its mechanism of action. Ketamine acts primarily on NMDA glutamate receptors, and glutamate is the brain’s primary excitatory neurotransmitter—central to learning, memory, and the sustained activation of threat-response circuitry. By temporarily blocking NMDA receptors, ketamine may influence glutamatergic signaling and neuroplasticity-related processes. Researchers have proposed that these effects could support prefrontal regulation of fear circuitry, but this has not been established as a clinical mechanism in panic disorder specifically. (Banov et al., 2020; Whittaker et al., 2021)
A smaller body of research has examined ketamine in anxiety disorders. Early clinical studies have reported reductions in anxiety symptoms following ketamine administration in treatment-refractory generalized anxiety and social anxiety disorders, with some changes appearing within hours to days. However, the evidence base for ketamine in panic disorder specifically is smaller and less robust than the evidence for treatment-resistant major depression. We do not present it as a proven standard of care; we discuss it as an off-label option with a reasonable biological rationale and preliminary clinical support. (Glue et al., 2020; Whittaker et al., 2021)
Preparing for the Ketamine Infusion Experience
One of the first barriers we encounter with panic disorder patients is concern about how the ketamine infusion experience itself will feel. Given that panic attacks are characterized by intense physiological arousal and fear of losing control, the prospect of entering an altered state of consciousness can provoke significant anticipatory anxiety.
We address this proactively in our consultation process. Dr. Seif takes time to explain what the infusion experience may involve, including dissociation and perceptual changes that can occur during treatment. Our team is present throughout, and we use a careful titration approach for anxious patients to minimize the likelihood that the dissociative state intensifies rather than calms the arousal experience.
The second barrier is the long history many patients with severe panic disorder have with treatments that have not worked. By the time someone reaches our clinic in Newport Beach, they may have tried multiple SSRIs, gone through more than one course of CBT, and spent years managing their world around their disorder rather than recovering from it. This history can produce a protective skepticism—a reluctance to invest emotionally in a new treatment. We respect that skepticism. We do not ask patients to believe in advance that ketamine will work; we ask them to evaluate the evidence with us and make an informed decision about whether it is worth exploring in their specific case.
Our Approach at OC Ketamine Therapy
A standard initial course of IV ketamine at our clinic involves a series of infusions over two to three weeks, each administered in our Newport Beach clinic under the direct supervision of Dr. Seif. We monitor patients throughout the infusion and remain available to provide verbal reassurance if anxiety arises during the experience. The infusion state typically resolves within 30 to 60 minutes of the end of the session.
We may also discuss combining ketamine with ExoMind TMS for patients whose panic disorder co-occurs with major depression. We can also integrate IV Vitamin Therapy into care plans where nutritional deficiencies may be contributing to anxiety vulnerability. Results vary by individual, and we always encourage patients to continue working with a skilled psychotherapist alongside any biological intervention we provide. Discuss with your provider whether this treatment is appropriate for you.
Frequently Asked Questions
Is IV ketamine safe for someone with panic disorder who fears losing control?
This is one of the most common concerns we hear, and it is entirely understandable. We address it in detail during the consultation and prepare patients carefully for what the infusion experience may involve. For highly anxious patients, we use a conservative approach to dosing and titration to minimize feelings of overwhelm. Individual experiences vary.
Is ketamine FDA-approved for panic disorder?
No. IV ketamine is not FDA-approved for panic disorder or any psychiatric indication. Its use for panic disorder is off-label and based on neurobiological rationale and preliminary clinical evidence. We discuss this clearly with every patient before recommending any treatment. (Whittaker et al., 2021)
How quickly might ketamine reduce panic attacks?
Some early studies in other treatment-resistant anxiety disorders have reported reductions in anxiety symptoms within hours to days of ketamine administration. However, this timing has not been established for panic disorder specifically, and individual responses vary significantly. (Glue et al., 2020; Whittaker et al., 2021)
Can ketamine be used while taking SSRIs or benzodiazepines for panic?
In many cases, medication decisions can be evaluated during consultation. We conduct a thorough medication review and provide individualized guidance regarding timing and safety. We never recommend discontinuing existing medications without coordinating with your prescribing physician.
Does ketamine help with the agoraphobia that often develops from severe panic disorder?
Agoraphobia—the avoidance of situations where escape might be difficult during a panic attack—can develop as a consequence of severe panic disorder. Exposure-based psychotherapy remains a primary treatment for agoraphobia. While ketamine may reduce anxiety symptoms for some patients, its role in making exposure therapy more accessible for agoraphobia has not been established. We recommend pursuing this exposure work with a skilled psychotherapist alongside any ketamine treatment. (NIMH, n.d.-b; Whittaker et al., 2021)
Key Takeaways
- Panic disorder affects roughly 4.7 percent of U.S. adults during their lifetime and can progress to life-limiting agoraphobia when first-line treatments provide insufficient relief. (NIMH, n.d.-a, n.d.-b)
- IV ketamine acts on NMDA glutamate receptors and is being studied for its possible effects on anxiety and fear-related circuitry. (Banov et al., 2020)
- The evidence for ketamine specifically in panic disorder is preliminary; IV ketamine is used off-label for this indication. (Whittaker et al., 2021)
- At OC Ketamine Therapy, we prepare anxious patients carefully for the infusion experience and use conservative dosing approaches for those with high anticipatory anxiety.
- Results vary by individual; ketamine may be considered as part of a plan that includes psychotherapy and coordination with existing prescribers.
Conclusion
Panic disorder at its most severe is a condition that narrows the world—one avoided situation, one cancelled trip, one relationship strained by the logistics of managing an unpredictable alarm system. We do not offer a cure, and we will never promise one. But for patients in Orange County who have done everything right by conventional standards and are still not well, we believe you deserve to know about every option that has a credible mechanism and emerging evidence behind it. Schedule a consultation with Dr. Seif when you are ready. We are here when you are ready.
About Dr. Dina Seif
Dina Seif, MD, believes that with the right mindset and support, every one of us has the potential to transform and heal our minds. She specializes in creating a personalized plan for each patient and is committed to providing a supportive healing environment for your journey. Dr. Seif is a member of the American Society of Ketamine Physicians and was recognized as a Physician of Excellence by the Orange County Medical Association. Dr. Seif has 15+ years of experience with ketamine in the emergency setting and founded one of the first ketamine practices in Orange County in 2019. She has administered thousands of infusions and cared for hundreds of patients from around the world. Dr. Seif is board-certified in Emergency Medicine and is a graduate of the University of California, Irvine, where she attended college, medical school, and business school. After an internship in Internal Medicine at St. Vincent’s Medical Center in New York, she returned to California for Emergency Medicine residency at LAC+USC Medical Center, where she also completed a fellowship in Emergency Ultrasound and was a Professor of Clinical Emergency Medicine at Keck School of Medicine of USC for five years.
References
Banov, M. D., Young, J. R., Dunn, T., & Szabo, S. T. (2020). Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: A review of the literature. CNS Spectrums, 25(3), 331–342. DOI: 10.1017/S1092852919001238
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11, 595584. DOI: 10.3389/fpsyt.2020.595584
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. DOI: 10.1177/0269881119874457
National Institute of Mental Health. (n.d.-a). Panic disorder. National Institutes of Health.
National Institute of Mental Health. (n.d.-b). Panic disorder: What you need to know. National Institutes of Health.
Sobanski, T., & Wagner, G. (2017). Functional neuroanatomy in panic disorder: Status quo of the research. World Journal of Psychiatry, 7(1), 12–33. DOI: 10.5498/wjp.v7.i1.12
Walsh, Z., Mollaahmetoglu, O. M., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D. J., & Morgan, C. J. A. (2021). Ketamine for the treatment of mental health and substance use disorders: Comprehensive systematic review. BJPsych Open, 8(1), e19. DOI: 10.1192/bjo.2021.1061
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
Medical Disclaimer
The information provided in this blog is for educational purposes only and does not constitute medical advice. Treatment outcomes vary by individual. Results may vary. Please consult with a qualified healthcare provider before beginning any new treatment. Discuss with your provider whether this treatment is appropriate for you.