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Sarah Brand

Sarah Brand

Can exposure-based CBT extend the effects of intravenous ketamine in obsessive-compulsive disorder? an open-label trial. J Clin Psychiatry.

Rodriguez CI, Wheaton M, Zwerling J, Steinman SA, Sonnenfeld D, Galfalvy H, Simpson HB. Can exposure-based CBT extend the effects of intravenous ketamine in obsessive-compulsive disorder? an open-label trial. J Clin Psychiatry. 2016 Mar;77(3):408-9. doi: 10.4088/JCP.15l10138. PMID: 27046314; PMCID: PMC5544939.

Highlights:

  • IV ketamine can rapidly reduce obsessions in unmedicated OCD patients and advance the growing literature of enhancing CBT with agents that facilitate extinction learning.
  • The data suggest that a brief course of CBT may help some individuals maintain the improvement they experienced from ketamine; however, this needs to be formally tested in a randomized controlled trial to determine whether the improvement seen after two weeks of CBT is due to the addition of CBT, or whether the effects of ketamine persist longer in some than previously described.
  • Of the 10 patients who started ketamine, nine completed the infusion. Eight reported a rapid reduction in obsessive severity as measured by the OCD-VAS, which persisted up to 230 minutes post-infusion in seven patients.

Conclusions:

These results corroborate prior findings1, 2 that IV ketamine can rapidly reduce obsessions in unmedicated OCD patients and advance the growing literature of enhancing CBT with agents that facilitate extinction learning. 7, 8, 17 Limitations typical of an open-label trial include lack of randomization to a comparison group, which may lead to allocation and ascertainment (response) bias. The data suggest that a brief course of CBT may help some individuals maintain the improvement they experienced from ketamine; however, this needs to be formally tested in a randomized controlled trial to determine whether the improvement seen after two weeks of CBT is due to the addition of CBT, or whether the effects of ketamine persist longer in some than previously described.

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