Ketamine for OCD

Obsessive-compulsive disorder (OCD) is a brain-based anxiety disorder that causes considerable suffering and impairment.

• Ketamine is an old drug with some new uses
• Ketamine can help reduce the symptoms of many mental health conditions
• Research on ketamine for OCD is still in the early stages
• Ketamine combined with exposure therapy has shown promise as a long-lasting approach, while stand-alone benefits are only temporary
• Ketamine can be a valuable tool for people who have treatment-resistant OCD

Ketamine, while having only recently become a subject of research for the treatment of OCD, has been used safely in medicine for decades. Initially employed as an anesthetic (a use it retains, specifically for children), ketamine was found to have psychedelic qualities. Research into the use of psychedelic drugs to treat mental health conditions is advancing rapidly, and has shown robust and lasting benefits.

Ketamine, as such, has been a major subject of interest in this growing field. Being one of the few psychedelic drugs that are legal to use, it is being employed for a wide variety of conditions. The condition at the center of most ketamine research has been depression. Ketamine treatments for depression have been astounding successes; with just one dose, individuals with severe depression can begin to feel normal again, and experience joy and happiness for the first time.

The success in using ketamine to treat depression led researchers to wonder what other conditions could be treated using the drug. There has been speculation that because OCD and depression are so often found together, ketamine could be used as an OCD treatment. When individuals have both conditions, the Exposure and Ritual Prevention (EX/RP or ERP) is not conducive to success because they often do not have the energy to persistently follow the plan. This has led to questions as to whether ketamine could be used as a treatment option in these cases.

One of the ways psychedelic therapy works is by diminishing barriers in the mind that prevent people from understanding themselves and their motivations. This then provides clients with a new perspective about their life and situation while increasing neurotransmitters associated with positive feelings, elevating the person’s mood.

A pioneering researcher in this area is Dr. Carolyn Rodriguez of Stanford University whose research focuses on helping those with OCD. Among her research, her team found a dramatic reduction of symptoms in a patient with severe OCD after receiving ketamine infusions (Rodriguez et al., 2011).

The main issue with treating OCD with ketamine is that the gains people make tend to be short lived (Sharma et al., 2020). This is often the case when using ketamine for depression as well, which is why people with severe depression usually need to keep going back to maintain improvements.

Recent studies are showing when paired with psychotherapy, ketamine can be incredibly effective with longer lasting gains so constant dosing is not necessary. This is known as ketamine-assisted therapy (or KAP). Research studies are finding that ketamine-assisted therapy is useful for a number of problems including depression, PTSD, complex PTSD, race-based trauma, generalized anxiety disorder, substance abuse including alcoholism. and ADHD; gains are also seen for people with OCD (Dore et al., 2019; Halstead et al, 2021).

Some studies show that for OCD, ketamine plus psychotherapy alone is only somewhat effective. However, most clinicians are just using regular psychotherapy for KAP, which is not an effective treatment for OCD. When paired with Exposure and Ritual Prevention (EX/RP or ERP), KAP is believed to produce a stronger effect with longer lasting gains (Rodriguez et al., 2018).

ERP is effective and has been proven to be the gold standard, typically the best, for treatment of OCD. While it can be challenging to implement, if followed properly, it almost always leads to long-term improvement. Ketamine alone can help, but should not be considered a cure, rather a tool or catalyst in assisting the therapy process to bring about lasting changes. Many of the antidepressant drugs used to treat OCD help more by dampening emotions and anxiety, as opposed to treating it. Ketamine does not have these side-effects.

Ketamine is now being more commonly used at numerous mental health clinics to help people suffering from OCD. This could be a good option for those who suffer severely from OCD, for those who have tried ERP without success, or for those in situations with OCD and crippling depression. In these cases, ERP and ketamine should be used together. However, ERP therapy remains the best stand-alone treatment for most people with OCD.

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