Clinical conditions

Specific diagnoses, specific evidence

These are clinical deep-dives on specific psychiatric conditions — DSM-5-TR and ICD-11 diagnostic criteria, evidence-based first-line treatments, how each condition differs from related diagnoses, and where ketamine fits within that specific clinical picture. Written for patients who want the clinical detail, not the brochure.

Ketamine is one option, not the only option. Each page describes the full first-line treatment landscape honestly — and where ketamine reasonably enters the picture (usually after standard treatments have been adequately tried).

Clinical condition

Dysthymia (Persistent Depressive Disorder)

DSM-5-TR 300.4 / ICD-10 F34.1

Persistent depressive disorder (PDD) — two or more years of low-grade depression that patients often mistake for personality rather than illness. Frequently treatment-resistant to first-line antidepressants. Distinct clinical picture from major depressive disorder.

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Clinical condition

Social Anxiety Disorder (SAD)

DSM-5-TR 300.23 / ICD-10 F40.10

Clinical social anxiety disorder — distinct from situational shyness. Performance anxiety, fear of judgment, persistent avoidance. SSRIs and CBT first-line; beta-blockers for performance subtype; ketamine as an option when standard treatments fail.

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Clinical condition

Panic Disorder

DSM-5-TR 300.01 / ICD-10 F41.0

Recurrent unexpected panic attacks plus persistent worry or behavior change between attacks. Distinct from isolated panic attacks (a symptom that can occur in many conditions). SSRIs, CBT, and exposure-based therapy first-line; ketamine relevant when standard treatments fail.

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Clinical condition

Agoraphobia

DSM-5-TR 300.22 / ICD-10 F40.00

Marked fear of two or more agoraphobic situations — public transport, open spaces, enclosed spaces, crowds, being outside home alone. Frequently comorbid with panic disorder. Exposure therapy is gold standard; ketamine may have a role when severity prevents exposure work.

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Clinical condition

Treatment-Resistant Depression (TRD)

No distinct ICD code — specifier on F33.x

Major depressive disorder with inadequate response to at least two adequate trials of antidepressants from different classes. Ketamine and esketamine (Spravato) are the FDA-acknowledged rapid-acting options. STAR*D outcomes inform escalation strategy.

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Clinical condition

Bipolar 2 Depression

DSM-5-TR 296.89 / ICD-10 F31.81

Bipolar 2 disorder — hypomanic episodes plus major depressive episodes, without full manic episodes. The depressive phase dominates the clinical course. Ketamine in bipolar 2 requires concurrent mood stabilizer because of mania induction risk.

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Clinical condition

Postpartum Depression (PPD)

DSM-5-TR 296.x with peripartum onset specifier / ICD-10 F53.0

Major depressive episode with onset during pregnancy or within four weeks of delivery (DSM-5-TR peripartum specifier). Brexanolone (Zulresso) and zuranolone (Zurzuvae) are FDA-approved PPD-specific options. SSRIs, psychotherapy, and breastfeeding considerations inform treatment.

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Clinical condition

Seasonal Affective Disorder (SAD)

DSM-5-TR — major depressive disorder with seasonal pattern specifier

Major depressive episodes with regular seasonal pattern — most commonly winter-onset depression with spring/summer remission. Light therapy is first-line; CBT-SAD has comparable evidence. Ketamine for resistant cases or summer-onset variants.

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Clinical condition

Complex PTSD (C-PTSD)

ICD-11 6B41 (distinct from DSM-5-TR PTSD)

ICD-11 recognized clinical entity distinct from DSM-5-TR PTSD. Cumulative or relational trauma producing classical PTSD symptoms plus disturbances in self-organization. Treatment is stage-based with longer trajectory than acute PTSD.

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Clinical condition

Treatment-Resistant Anxiety

No distinct code — specifier on F40-F48

Anxiety analog to TRD. Failure of adequate trials of multiple anxiolytics, SSRIs, and CBT in generalized anxiety disorder, panic disorder, social anxiety disorder, or related conditions. Less FDA-acknowledged than TRD but real clinical entity.

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Clinical condition

Premenstrual Dysphoric Disorder (PMDD)

DSM-5-TR 625.4 (N94.3) / ICD-11 GA34.41

Severe luteal-phase mood, irritability, and depressive symptoms that remit within days of menses onset. A distinct DSM-5-TR diagnosis — not "bad PMS." SSRIs (luteal or continuous dosing) and drospirenone-containing oral contraceptives are first-line. Ketamine is NOT a primary PMDD treatment.

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Clinical condition

Health Anxiety (Illness Anxiety Disorder)

DSM-5-TR 300.7 (F45.21) / ICD-11 6B23

Illness anxiety disorder — preoccupation with having or acquiring a serious illness despite minimal or absent somatic symptoms and reassuring medical evaluation. Formerly hypochondriasis. CBT and SSRIs are first-line. Distinct from somatic symptom disorder and OCD.

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Clinical condition

Generalized Anxiety Disorder (GAD)

DSM-5-TR 300.02 / ICD-10 F41.1 / ICD-11 6B00

Chronic, excessive, hard-to-control worry across multiple life domains for six or more months, with physical symptoms (restlessness, fatigue, muscle tension, sleep disturbance). GAD-7 is the standard screen. SSRIs, SNRIs, buspirone, and CBT are first-line; ketamine for treatment-resistant GAD with comorbid depression.

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Clinical condition

Adjustment Disorder

DSM-5-TR 309.x / ICD-10 F43.2 / ICD-11 6B43

A stress-response disorder — emotional or behavioral symptoms developing within three months of an identifiable stressor, out of proportion to the stressor, and resolving within six months of its end. Distinct from major depression and PTSD. Psychotherapy is first-line; usually time-limited. Ketamine is rarely indicated.

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High-volume conditions: the most common diagnoses — depression, anxiety, PTSD, OCD, chronic pain — have their own dedicated pages. Ketamine for depression, anxiety, and PTSD cover the conditions most patients search for first. The pages here cover the more specific clinical entities.

Not sure where you fit? The eligibility assessment reviews your specific diagnosis and treatment history. A physician determines whether ketamine therapy is appropriate for your situation — these pages are educational, not a substitute for clinical evaluation.