Obsessive-compulsive disorder (OCD) is a pretty common mental health issue affecting about 1-2% of people globally. Of course, real numbers might be much higher as many, if not most, are not seeking medical help for this relatively benign condition. Although the condition is not life-threatening, it causes much distress. If you are among those who cannot stop repeating certain actions for no reason, you might be living with the condition.
The condition is pretty easy to diagnose. Most of those living with the condition are aware of their problem. Moreover, people around them can also notice that a person is obsessed with specific thoughts and actions.
This condition has two factors: obsession and compulsion. It means that the person is not just obsessed with carrying out specific actions, having a fear of germs, and having certain thoughts, but one also has an urge or compulsion to carry out specific actions like washing hands, frequently checking if the door is closed, praying, and so on. A person living with OCD cannot control thoughts and specific actions.
As one can see, most of those actions do not harm anyone, but they cause distress. Repeatedly washing hands or checking if the door is closed is not a big issue. However, these problems do cause much discomfort. Moreover, many of these individuals might even have some motor tics like eye movements, shrugging shoulders, and repetitive throat clearing. Some of these issues might cause pain.
Managing the condition remains quite challenging. Many people living with OCD might also show signs of severe anxiety or other mental health issues. Doctors may use anxiolytics, antidepressants, and other medications to manage the condition. However, the effectiveness of these approaches is not proven.
Perhaps the more effective way of managing these issues is through psychotherapy. It is about helping people change their habits and slowly eliminate repetitive behavior. Cognitive behavior therapy (CBT) that helps alter thought patterns is the “gold standard” in managing the condition.(1)
However, the problem with the abovementioned treatment approaches is that they work slowly—moreover, they fail to help in a large number of cases. Therefore, researchers are looking for novel ways to manage the condition. A kind of therapy that could help quickly and provide prolonged relief.
Early studies have shown that ketamine is good for various mental health issues like anxiety and depression. Moreover, it works pretty fast, and its impact is long-lasting. Even more interesting is to note that ketamine is good to combine with CBT. It makes people more receptive to suggestions and helps people change long-established thought patterns. So, why not consider using ketamine therapy for OCD?
Ketamine for OCD: What Does Science Say?
There are not many drugs known to work for OCD. Thus, the US FDA has approved only serotonin reuptake inhibitors (SRIs). However, these medications have many issues. They are slow to act, often taking weeks or even months to start acting. They might help a bit with anxiety or depression and help stabilize mood. However, it is unclear if they can help reduce OCD signs and symptoms. Thus, there is a need to find treatments that are more effective and work faster. Ketamine therapy provides much hope for managing OCD.
Doctors have been using ketamine to manage anxiety and OCD for the last few years. Many clinics have reported excellent results. Hence, in the last few years, researchers and the pharmaceutical industry have also become interested in exploring the role of ketamine in managing OCD. At least, early studies show that it may greatly help the condition.
Good for Quick Relief
In one of the exploratory studies, researchers gave ketamine to 8 patients living with OCD. They also gave a placebo to another eight patients for comparison. Ketamine is generally given as a slow infusion over 40 minutes in a clinic. Typically, patients have to stay in the clinic for a few hours post-ketamine infusion. This exploratory study found that ketamine was good in many ways. It was much better than a placebo, helping reduce OCD in most cases. However, what researchers liked is that ketamine helps almost instantly. Those living with OCD report almost instant relief. Further, they found that just one slow ketamine infusion delivered over 40 minutes was enough to provide relief for a week.(2)
So, what is good about ketamine is that it works pretty fast. This is unlike all the existing OCD treatment options. This makes ketamine quite a unique OCD treatment. However, researchers are also amazed by its long-lasting impact, which means that there is no need for frequent dosing. Just one IV infusion a week may help. There are now few studies showing that these benefits of ketamine are due to some long-lasting brain changes. Like in certain brain parts, it may boost GABA levels, one of the inhibitory neurotransmitters.(3)
Rapid OCD Relief Even in Resistant Patients
Yet another important thing to note about ketamine is that it can work in resistant cases. This shows that it works, unlike other drugs that mostly act on serotoninergic pathways. For example, most approved drugs or SRIs can barely help in half of the cases. However, in some pilot studies, researchers have found that ketamine works where other treatments fail. It means that ketamine is not just quick but helps in resistant cases.(4)
Here, one more thing is also worth understanding: OCD rarely occurs alone in patients. Many of those living with OCD have other mental health issues like anxiety and depression. Studies show that ketamine is not just good for overcoming OCD but also anxiety and depression. In fact, its impact on depression is even more pronounced.(5)
Sure, there are some controversies regarding how long ketamine works and how effective it is for OCD. Some studies found that it is more effective for about three days, and after that, its impact subsides. There are also few studies showing only mild benefits. Nonetheless, there is no doubt that most studies show ketamine’s benefit, and thus, the therapy is worth exploring in patients living with OCD.
Long-lasting Benefits of OCD
Ok, so now we know that ketamine works pretty quickly and may help for about a week. Thus, it means that one would need to repeat ketamine IV therapy on a weekly basis. This will ensure two things: quick control of OCD within a few hours of the first infusion and prolonged benefit.
However, now researchers are exploring the benefits of multiple ketamine IV therapy. Studies show that if ketamine therapy is repeated a few times, it may result in significant behavioral changes in those living with OCD. (6)
This is good news that ketamine can help rewire the brain and provide prolonged relief. Other oral drugs are just good for controlling OCD symptoms. They work for only as long as one is taking those medications. Once the patient stops taking those oral drugs, OCD returns pretty quickly. This is because oral drugs just suppress OCD signs and symptoms. However, ketamine promotes certain brain changes, ensuring prolonged relief from the condition.
Of course, there are still some knowledge gaps. Researchers do not know for how long one should use IV ketamine therapy to experience prolonged benefits. Hopefully, some new studies would help shed more light on the topic, as any patient would like to know for how long to continue using ketamine therapy.
Nevertheless, there is some sound evidence that ketamine is not just symptomatic relief, but it can also alter the course of the disease. Thus, researchers recently analyzed data from nine robust studies regarding ketamine use for managing OCD. They found that ketamine is good for managing OCD. Of course, researchers noticed that more studies are needed to understand a few things. Most studies to date had small sample sizes; thus, much remains to be understood about ketamine’s role in managing OCD.(7)
Even Better When Combined with Cognitive Behavior Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that is regarded as a golden standard in OCD. This is because OCD might start with stress, anxiety, and some brain changes. However, it is also about learned behavior or habits. Thus, many things can be changed by altering thinking patterns.
CBT operates on the premise that maladaptive thoughts and behaviors contribute to psychological distress. Aaron Beck and Albert Ellis pioneered this approach, emphasizing the interconnectedness of cognition, affect, and behavior.(8)
In the context of OCD, individuals often experience intrusive thoughts (obsessions) and engage in repetitive behaviors (compulsions) to alleviate anxiety. CBT targets these cognitive distortions and dysfunctional behavioral patterns through structured interventions.
However, altering long-established habits is not easy. Moreover, over the years, OCD causes brain changes that are difficult to alter. Of course, with sufficient effort, one can overcome even long-established habits and alter brain functioning. However, it is challenging without help.
What is good about ketamine therapy is that studies on various other mental health issues have already shown that it increases the effectiveness of psychotherapy. This is because ketamine improves brain plasticity and it makes individuals more receptive to various instructions.
There is some strong evidence from early studies that combining CBT and ketamine IV therapy may be a good idea. Clinical studies show that CBD carried post ketamine IV therapy results in better effects due to improved learning and enhanced brain plasticity.(9)
IV Ketamine Is the Best Option
Before we continue looking at other things like its safety and possible mechanism of action, it is worth understanding that, at present, most research regarding ketamine use is regarding IV therapy. There are many reasons for preferring IV therapy.
Ketamine is also a substance of abuse and is sold as an illicit drug. However, one should never use those illicit drugs as it is not just illegal to buy them. They are also harmful due to toxicity and impurities.
Of course, theoretically, ketamine may be made available as tablets. Further, there are also intranasal forms of the drug. However, a problem with tablets is their slow action, and they are not as good for mental health issues as IV therapy due to low bioavailability. Moreover, one is more likely to abuse tablets and develop ketamine dependence.
There are similar kinds of issues with intranasal ketamine. Such a ketamine is not a perfect choice for managing OCD. Intranasal does work quickly, but it is good for taking ketamine in smaller amounts, which is insufficient to manage OCD. Moreover, studies show that people do not like using intranasal drugs. Even worse, intranasal ketamine is more likely to cause certain side effects like headaches.(10)
How Safe is Ketamine for OCD?
There is an old saying in medicine that the difference between medicine and poison is in the dosage. The most potent lifesaving drug would kill a person in the wrong dose. However, if medications are used as intended, they can boost health and well-being. The same is true for ketamine; it is safe and can help manage OCD when used responsibly.
Ketamine is also a substance of abuse and is even sold as an illicit drug. When abused, it can cause dependency, addiction, and harm health. It can cause nausea, vomiting, blurring of vision, altered perception, dissociative symptoms, and more.
However, ketamine is also used as an anesthetic and painkiller. In medicine, it is mostly used as an IV infusion. In anesthesia, doctors may use high-dose ketamine injections. However, for managing anxiety, OCD, and other mental health issues, doctors use low-dose ketamine, which does not make a person unconscious. Of course, it still causes some nausea and dissociative symptoms, but these unpleasant effects last for about a couple of hours only.
Thus, patients have to stay for a few hours in a clinic after the infusion. However, individual sensitivities vary, and some may be able to go home after a couple of hours. Others may need to stay in a clinic a bit longer.
When used under medical supervision for OCD, it is used at lower dosages and only as a once-a-week IV infusion. This makes it quite safe and does not cause long-term toxicity.
Here, it is vital to understand that ketamine nasal spray is available and is US FDA-approved for managing resistant depression. However, this particular form of ketamine is not good for managing OCD, and it is not proven to work.
The Bottom Line
Obsession with specific actions and compulsion to keep carrying out certain acts is quite challenging to alter. This is both a mental health issue and a component of learned behavior. This means that though the condition may start due to some mental health issue or brain changes, habit is formed over time. This is vital to realize, as any OCD treatment would work better when combined with psychotherapy. That is why, in modern medicine, CBT remains the gold standard for managing the condition, which teaches people living with OCD to alter their responses to various extrinsic and intrinsic triggers.
However, this does not mean that medications have no place in managing the condition. Medications can make a significant difference. However, in modern medicine, there are not many treatment options. There are few drugs that target serotonergic pathways in the brain. This may improve mood, alleviate fears, reduce anxiety and depression, and thus help with OCD. However, these drugs are very slow and take weeks to start working. Hence, researchers are looking for faster and more effective ways of managing the condition. This is where ketamine comes into play.
Of course, do not expect ketamine to work in all the cases. But, studies show that it works for many and acts quickly, that is, within hours. Just a single session of ketamine IV therapy is beneficial, reducing stress, anxiety, depression, and fears and suppressing the urge to carry out some irrelevant actions. Hence, it can be quite good for managing OCD.
A single ketamine IV session can help reduce OCD for a week. This means that ketamine also has a prolonged effect. Further, repeated ketamine IV therapies may even help some individuals get rid of OCD completely.
Since ketamine barely remains in the body for more than 24 hours, its prolonged action is difficult to explain. Researchers think such a prolonged action may be due to permanent brain changes like enhanced brain plasticity. Ketamine promotes brain rewiring. Thus, repeated therapy with ketamine would ensure some permanent brain changes, helping cure OCD.
Yet, another important thing to keep in mind is that studies show that ketamine works better when combined with CBT. This is because ketamine makes people more receptive to suggestions. Further, ketamine also helps alter thinking patterns due to its positive impact on brain plasticity.
To sum up, ketamine IV therapy provides much hope for managing distressing conditions like OCD, which is quite challenging to treat with existing therapeutic approaches. Moreover, IV ketamine is very safe as it is done strictly under medical supervision. Hence, such a low-dose IV ketamine does not cause dependence, and any of its side effects are short-lasting, but its benefits are long-lasting.
References
- Obsessive-Compulsive Disorder – National Institute of Mental Health (NIMH) [Internet]. [cited 2024 Mar 4]. Available from: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
- Rodriguez CI, Kegeles LS, Levinson A, Feng T, Marcus SM, Vermes D, et al. Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder: Proof-of-Concept. Neuropsychopharmacol. 2013 Nov;38(12):2475–83.
- Rodriguez CI, Kegeles LS, Levinson A, Ogden RT, Mao X, Milak MS, et al. In vivo effects of ketamine on glutamate-glutamine and gamma-aminobutyric acid in obsessive-compulsive disorder: Proof of concept. Psychiatry Research: Neuroimaging. 2015 Aug 30;233(2):141–7.
- Rodriguez CI, Kegeles LS, Flood P, Simpson HB. Rapid Resolution of Obsessions After an Infusion of Intravenous Ketamine in a Patient With Treatment-Resistant Obsessive-Compulsive Disorder. J Clin Psychiatry. 2011 Apr 15;72(4):16895.
- Bloch MH, Wasylink S, Landeros-Weisenberger A, Panza KE, Billingslea E, Leckman JF, et al. Effects of Ketamine in Treatment-Refractory Obsessive-Compulsive Disorder. Biological Psychiatry. 2012 Dec 1;72(11):964–70.
- Thompson SL, Welch AC, Iourinets J, Dulawa SC. Ketamine induces immediate and delayed alterations of OCD-like behavior. Psychopharmacology. 2020 Mar 1;237(3):627–38.
- Bandeira ID, Lins-Silva DH, Cavenaghi VB, Dorea-Bandeira I, Faria-Guimarães D, Barouh JL, et al. Ketamine in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review. Harvard Review of Psychiatry. 2022 Apr;30(2):135.
- Ruggiero GM, Spada MM, Caselli G, Sassaroli S. A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes. J Ration Emot Cogn Behav Ther. 2018;36(4):378–403.
- Rodriguez CI, Wheaton M, Zwerling J, Steinman SA, Sonnenfeld D, Galfalvy H, et al. Can Exposure-Based CBT Extend the Effects of Intravenous Ketamine in Obsessive-Compulsive Disorder? An Open-Label Trial. J Clin Psychiatry. 2016 Mar 23;77(3):7005.
- Rodriguez CI, Lapidus KAB, Zwerling J, Levinson A, Mahnke A, Steinman SA, et al. Challenges in Testing Intranasal Ketamine in Obsessive-Compulsive Disorder. J Clin Psychiatry. 2017 Apr 26;78(4):2474.
