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Ketamine for OCD

People diagnosed with obsessive-compulsive disorder (OCD) may experience anxiety without any seemingly apparent reason.  OCD is considered a type of anxiety disorder that has two main components as its name suggests:  obsessions and compulsions.  People with OCD experience unwanted, intrusive, compelling,and distressing thoughts, images, or urges (obsessions), which lead to repetitive behaviors or mental acts aimed at reducing the anxiety or preventing a feared outcome (compulsions). 

OCD often interferes with daily life and can become time-consuming and distressing.  It is important to note that having occasional and mild obsessions or compulsive tendencies does not necessarily indicate a diagnosis of OCD.  For a diagnosis of OCD, these symptoms must be severe, persistent, and cause significant impairment in the person’s functioning or well-being.  As with any mental health disorder, a professional medical or mental health provider should assess and diagnose an individual. 

Ketamine for OCD
Ketamine for OCD

Ketamine Has Shown Promising Results in Treating OCD

Ketamine therapy has shown to be an effective treatment for OCD as well as symptoms of anxiety and depression that is typically co-morbid with OCD.  Ketamine has been found to promote neuroplasticity, which facilitates the repair of damaged neural connections, restructuring on damaged brain structures, and the formation of new synaptic connections in the brain.  All of these properties of ketamine helps rewire dysfunctional neural connections that contribute to OCD symptoms.  

What Are the US Statistics for OCD

Prevalence

Prevalence

OCD is estimated to affect approximately 1.2% of adults in the United States in a given year, which equates to around 2.8 million adults.

Age of onset

Age of onset

OCD often develops in childhood or adolescence, with the median age of onset being 19 years old

Gender differences

OCD affects both men and women equally.

Comorbidity

OCD is often accompanied by other mental health disorders, with up to 90% of individuals with OCD experiencing at least one comorbid disorder, such as depression or anxiety.

Disability

Disability

OCD can be a disabling condition, with approximately 50% of individuals with OCD experiencing moderate to severe impairment in their daily lives.

Access to treatment

Unfortunately, many individuals with OCD do not receive adequate treatment. One study found that only 10% of individuals with OCD receive appropriate treatment within the first year of symptom onset.

Understanding-OCD

Understanding OCD

OCD is an anxiety disorder characterized by recurring thoughts, ideas, or obsessions that trigger compulsive and/or repetitive behavior.  Individuals respond to their anxiety by performing compulsive rituals, such as repetitive cleaning or organizing things in a certain way.  This behavior provides temporary relief, but the irrational cycle oftentimes continues. 

Signs and symptoms may include anxiety, panic attacks, ritualistic behaviors, repeated thoughts and behaviors, and obsessive hoarding.  These behaviors are often centered around specific fears or beliefs, such as contamination or superstitions of harm of oneself or loved ones.

OCD symptoms differ from person to person in terms of the types of beliefs and behaviors, but also in intensity and frequency.  Some experience symptoms in childhood, while others develop them later in life.  Traumatic experiences may lead to the development of OCD, but many times, causes may be unknown.  

Obsessions Are Persistent

Obsessions are characterized by intrusive and irrational thoughts that continuously occupy one’s mind.  Obsessions are persistent and unwanted thoughts, images, or urges that cause significant anxiety and distress.  They can also manifest as compulsive behaviors that one feels the need to repeat over and over again.  Despite being aware that these thoughts and behaviors are irrational, individuals often are unable to stop because they often believe the obsession holds some truth.  People with OCD often try to suppress or ignore these obsessions, but they find it difficult or impossible to do so, leading to heightened anxiety.

Common obsessions associated with OCD include the need for objects to be arranged in a specific way, anxiety related to thoughts of harming oneself or others, fear of germs or dirt, concern about symmetry, order, or exactness, as well as unwanted or forbidden sexual or aggressive thoughts.  Additionally, individuals may experience anxiety with respect to safety, such as the house catching on fire, contracting an illness, or an intruder breaking in.

Compulsions Are Repetitive

Compulsions refer to repetitive or ritualistic behaviors that are compelld by an individual’s obsession.  These actions are usually aimed at reducing the anxiety or preventing a feared outcome associated with the obsession.  Common  compulsions associated with OCD include excessive hand washing or cleaning, repeating specific actions or rituals, continuously repeating words or phrases, arranging objects in a specific order until satisfied, and checking behaviors (i.e., repeatedly checking locks, doors, the stove, etc).  Compulsions are typically not logically connected to the feared event but are performed as an attempt to prevent the obsession from coming true.  

Conventional Treatments of OCD

OCD can cause distress for people, while others learn to live with it.  However, many individuals seek out OCD treatments to alleviate their symptoms and attempt to change their beliefs and behaviors.  Traditional treatments for OCD typically involve a combination of therapy and medication.  

Individual and group psychotherapy

Individual and group psychotherapy

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT)

Systematic desensitization

Systematic
desensitization

Prescription medications such as SSRIs

Prescription medications such as SSRIs and other antidepressants

OCD is characterized by persistent high anxiety levels, making symptom reduction a primary focus of treatment.  While various therapies are commonly employed for severe cases of OCD, traditional approaches may not be effective for everyone.   For those who do not experience relief from standard therapies, alternative treatments like Ketamine for OCD have shown promise and may offer a potential solution.

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.

Ketamine Treatment Options for OCD

AVYIA offers 3 ketamine programs that patients can choose from to treat their OCD.  Each program starts with a free telehealth evaluation for a medical intake, assessment, and eligibility.  One of doctors or providers will then visit you at home to facilitate the ketamine treatment of choice.  Follow-up are always over telehealth and/or in the comfort of your home where a provider visits.  

Intravenous (IV) Infusion:  This is the most common and widely studied method of ketamine administration.  In IV ketamine therapy, a controlled dose of ketamine is delivered directly into the bloodstream.  The infusion takes 40 minutes for most patients, and the effects are felt relatively quickly. 

Intranasal Spray:  Ketamine can also be administered through the nasal passage as a nasal spray.  Intranasal ketamine is often prescribed for who prefer an alternative to the intravenous route.  

Microdosing Oral tablets:  This option is a daily regime taken in oral form.  Rapid dissolving tablets of ketamine is designed to be absorbed sublingually or under the tongue.  This treatment program generally takes a little while longer to complete than the IV or intranasal program, but symptom relief may still be rapidly achieved, typically in the first days to a week of starting treatment.   

* Microdosing costs $150 per month for most patients. For patients who require higher dosages, the cost may increase due to the higher cost of the medication. Microdosing patients are required to have an at-home visit before commencing the medication.
How Can Ketamine Treat OCD

How Does Ketamine Treat OCD?

Ketamine therapy for OCD is a highly sought-after alternative treatment for a good reason.  In contrast to more conventional treatments like psychotherapy and prescription medicine, it has been discovered that intravenous ketamine therapy can help OCD patients see benefits much faster.  Ketamine-assisted therapy can be especially beneficial for those people who have tried traditional treatments with less than optimal results.

While medication and therapy can help manage OCD symptoms, many patients dislike the side effects of SSRIs or the idea of relying on medication for extended or indefinite periods of time.  Ketamine is different.  Many studies have report significant OCD symptom improvement with ketamine therapy after only one session.  Multiple treatment sessions have yielded long and lasting results for most.  Low-dose ketamine infusions have been found to be particularly effective in alleviating anxiety and low mood, reducing compulsive behaviors and obsessive thoughts associated with OCD.  After completing a course of ketamine treatment, exposure therapy can help patients regain a higher level of functioning and develop healthier routines to manage their everyday lives.

Rodriguez, C. I., Kegeles, L. S., Levinson, A., Feng, T., Marcus, S. M., Vermes, D., Flood, P., & Simpson, H. B. (2013). Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: Proof-of-concept. Neuropsychopharmacology, 38(12), 2475–2483. https://doi.org/10.1038/npp.2013.150

How Does Ketamine Work to Treat OCD?

Ketamine in several ways.  First, regulates the neurotransmitter glutamate in the nervous system, on NMDA receptor. This is then thought to result in relearning maladaptive behaviors and cognitive functions associated with OCD.  Second, research suggests that Ketamine promotes neuroplasticity, which is the brain’s ability to change, grow, and reorganize neural pathways. This is done by targeting pathways such as mTOR, eEF2 kinase inhibition, and BDNF synthesis.  Many experts believe the psychedelic and dissociative effects of ketamine are also responsible for neuroplasticity promotion.  The end result is the resetting of your brain’s mental and emotional state.

Unfortunately for those suffering from OCD, other mental health disorders are commonly experienced, such as anxiety, depression, bipolar disorder, impulse control disorder.  Ketamine treats all of these disorder as well and should strongly be considered as a first-line treatment if individuals suffer from multiple disorders.  

Zhang J, Qu Y, Chang L, Pu Y, Hashimoto K. (R)-Ketamine Rapidly Ameliorates the Decreased Spine Density in the Medial Prefrontal Cortex and Hippocampus of Susceptible Mice After Chronic Social Defeat Stress. Int J Neuropsychopharmacol. 2019 Oct 1;22(10):675-679. doi: 10.1093/ijnp/pyz048. PMID: 31504547; PMCID: PMC6822137.

FAQ

The dosage of ketamine used for OCD treatment is considered subanesthetic, or lower than anesthesia sedation doses.  It can vary depending on several factors, including the patient’s individual characteristics, the route of administration, and the treatment protocol used by the healthcare provider. For intravenous (IV) ketamine, a common starting dose for depression is typically around 0.5 mg/kg to 1 mg/kg, administered over a 40-minute to one-hour infusion.  For intranasal (IN) ketamine, the dosing may be different, with the typical dose ranging from 28 mg to 84 mg per session. For microdosing the level is generally even lower than IV and nasal, but patients may build up tolerance over time and the dosage may need to be adjusted. 

Ketamine therapy targets the psychological causes of OCD and may be able to provide rapid relief of symptoms.  It has the ability to rewire the brain and has been shown to reduce anxiety and obsessive thoughts.  In addition, Ketamine therapy can improve overall mental wellness.

No, you do not need a referral. 

For most individuals, IV or intranasal ketamine is well-tolerated and a pleasant experience.  The psychedelic or dissociative effects are enjoyed by some, enlightening for others, and mildly unpleasant to others.  Everyone’s experience is different. 

Side effects occasionally occur, with nausea being the most common.  Nausea is easily relieved with anti-emetics, or anti-nausea meds.  Transient elevated blood pressures are seen, but generally pose no harm to healthy individuals, as blood pressures normalize after completion of a treatment.

For microdosing, we avoid dosages that would cause psychedelic of dissociative effects.  Side effects are also well tolerated and rare.   A provider will teach the patient how to titrate (adjust dosage) and stay in contact with the patients to monitor his/her progress. 

Yes, we recommend that you continue to collaborate with your mental health provider for the management of psychotherapy. Ketamine treatment can be an effective tool in managing certain mental health conditions, but it is not a replacement for traditional therapies like psychotherapy or counseling. Your psychiatrist or therapist provides a comprehensive approach to your mental health, offering support, guidance, and strategies for managing your condition in conjunction with ketamine treatment.

No.  We encourage patients to continue taking all of their medications unless otherwise specified by their doctors.  Abruptly stopping mental health medications can have potentially dangerous outcomes.  Patients should notify their primary or mental health providers that they will be taking ketamine. 

It is advised that patients avoid taking benzodiazepines or prescribed narcotics on the day of their treatment. Opioid medications can also interact with ketamine, increasing the risk of sedation.  Opioids should be held 6 hours prior to an IV or intranasal treatment.  It is important to mention that alcohol and recreational drugs should not be used when receiving treatment. Combining ketamine with alcohol or recreational drugs can be dangerous and increase the risk of adverse effects.

For more frequently asked questions, please visit our FAQ page.