Ketamine for OCD: How it works, Pros and Cons
Can Ketamine help in treating OCD? In the United States, 1 in 100 children and 1 in 40 adults have OCD. This means that approximately 3 out of 100 people are Obsessive-Compulsive sufferers at some point in their lifetime. Considering how debilitating this illness can be, this statistic is discouraging.
Selective Serotonin Reuptake Inhibitors (SSRIs) and Cognitive Behavioral Therapy (CBT) are the most traditional treatments. Unfortunately, these only help around 50% of cases. Clearly, there is a need for new OCD therapies with much higher efficacy. Ketamine is a treatment option showing great potential.
Obsessive-Compulsive Disorder is an anxiety disorder characterized by obsessions, repetitive thoughts (ruminations) that provoke anxiety, and compulsive attempts to quell that anxiety in ways that often perpetuate it. OCD sufferers can become extremely anxious about both realistic and unrealistic threats to their health, family, future, and other facets of vulnerability.
The power of the OCD cycle is not about what particular fear, or how likely the feared outcome is to occur, but springs from the obsessive repetition of the excruciating cycle of anxious thoughts.
OCD is a leading cause of disability and a serious public health concern. Earlier treatment often precedes better outcomes. But, help is limited. Despite all that’s known and the magnitude of its societal and individual impacts, OCD is still a common, chronic condition.
Obsessive-Compulsive Disorder can take over a person’s life. Obsessive Compulsive Disorder causes obsessions that intrude on people’s thoughts as they carry out daily activities and also impede long-term goals.
Below are common examples:
- Anxiety about causing harm. This is when an individual obsesses over the possibility of hurting themselves or others, often people they care about and would never actually assault. To ease their fears they may repeatedly check their thoughts to “make sure” they wouldn’t actually follow through with it. Some people even hide potential weapons from themselves “just in case” they were overcome with an “uncontrollable impulse.” Sadly ironic, OCD patients get stuck in these cycles precisely because they WOULD NOT harm that person.
- Contamination obsessions requiring unending sessions of cleaning, washing, disinfecting, and attempting to achieve a state of certainty regarding cleanliness that they continually check and recheck.
- Some obsessional themes have no apparent physical compulsions. These purely obsessive, aka “Pure O” cases, can involve secretive and embarrassing thoughts about religious, sexual, or violent themes. Once the offending thought enters the mind it forces the person upon a mental treadmill trying to escape these ideations and “reestablish one’s innocence.” Again, people that suffer from OCD are compelled into rituals ironically BECAUSE they would never commit that transgression, hence why it bothers them so much.
- Hoarding involves collecting and refusing to relinquish possession of invaluable or unpractical objects. This behavior results from a thought cycle in which one cannot comfortably decide to let something go, even outright garbage or waste. Extreme hoarding behavior can lead to the filling of one’s home with useless or even dangerous materials like rotting food. Such cases will accumulate clutter to the point of destroying the property. Individuals in these scenarios are that anxious about possibly needing their “stuff” one day and resist giving it away.
- Symmetry obsessions come from discomfort with allowing things uncounted, unarranged, or unordered properly. Patients of this kind may constantly rearrange objects or carry out tasks in a particular order. They may also say words and sentences repetitively until they “feel” correct.
In order to rid themselves of distress, the sufferer engages in compulsive rituals (such as washing their hands or arranging objects in a particular order). These processes temporarily lessen the anxiety. Problematically, the fearful thoughts then reemerge with greater intensity.
The most commonly referenced ritual sprouts from an intense anxiety about “contamination.” Patients with contamination obsessions have an overwhelming need to keep away from what they perceive as filth or germs. Specific triggers of concern range from contact with dirt, bodily fluids, bathroom surfaces, and many others. To quell the stress of feeling in danger of being contaminated, a series of ritualistic hygiene-related compulsions kick in. A frequent depiction of OCD-like behavior is “over-cleaning,” such as washing one’s hands excessively, even to the point of scrubbing them raw.
Ruminations around themes of contamination can affect every aspect of a person’s life. As an example, consider the practical problem of a mother’s incapacitation she faces changing her baby’s diapers. Or, what about the patient who cannot even enter their dentist’s waiting room for fear of germs on the furniture or in the air?
After one endures the obsessive-compulsive cycles enough, they cement themselves into a fully uncontrollable mechanism. One may then be thoroughly incapacitated by the flood of horrifying thoughts from which they can’t find an escape.
People with obsessive-compulsive disorder present in varying degrees of severity. Some deal with a level of anxiety that is well-managed through therapy and medication, freeing them to live a normal life. Others become essentially frozen and incapable of escaping the terror of their own minds. Patients with severe COD can lose jobs, relationships, their homes, and their will to live. It is not surprising that such a tortuous condition is a leading cause of disability worldwide.
In the last decade, the body of mental health treatments has expanded. Sadly, highly effective OCD therapies are still lacking. One can only hope that incremental improvements in the approaches and innovations continue. Millions are holding on as new interventions come forward; interventions that decrease the resistance to therapeutic success, resulting in lower levels of anxiety and related functional impairments. As it stands, the highest success rates still lie at the intersection of medications and behavioral therapy.
First-line OCD treatment is pharmacologic interventions (such as selective serotonin reuptake inhibitors) and psychotherapy approaches (like cognitive behavioral therapy). Examples of SSRIs used to manage OCD include paroxetine, fluvoxamine, escitalopram, and fluoxetine. This condition often requires higher dosages than those given for Depression.
The medications, when successful, act as anti-obsessionals that disrupt the OCD cycles within the brain. Sadly, 40 to 60% of OCD patients experience little respite. And even for those that eventually find their symptoms reduced, 8-12 weeks are required for the onboarding titration and psycho-emotional benefits to take effect.
Because positive outcomes are so limited, augmented pharmacologic therapy is common to OCD treatment plans. For instance, SSRIs are often combined with atypical antipsychotics to boost therapeutic impact. However, antipsychotic augmentation is only considered after SSRI treatment has failed due to the mixture’s higher risk of serious side effects such as diabetes and tardive dyskinesia.
Physicians encourage psychotherapy along with all medication efforts. For OCD, this approach can prove effective, even to the point of parity with pharmacological treatments. Cognitive Behavioural Therapy (CBT) and Exposure Response Prevention (ERP) are touted as the most effective behavioral modification treatments, as they restructure thought patterns and prevent reinforcement of the OCD thought cycle.
CBT techniques question and modify ruminations. One learns to identify, challenge, and replace unrealistic and unhelpful thoughts. Surprisingly, patients discover that their mind’s internal interpretations of their thoughts have a major effect on their emotional reactions. As this realization and skill are established, the therapy teaches how to monitor one’s thoughts for these “cognitive distortions.” Then, the patient can reinterpret those thoughts in more realistic and comforting ways in daily life.
ERP treatment participants are first introduced into a situation that frightens them. Once in this fearful state, they experience a tremendous urge to reduce the anxiety by engaging in reassuring behaviors aka compulsions, like excessive handwashing, object arrangement, or checking to make sure a door is locked. This is where ERP comes in by prescribing the patient to prevent their usual compulsive response and endure the anxiety. Over time, the frightening stimulus loses its power to feed the cycle of distress. While a difficult therapeutic approach, ERP does get results, sometimes surpassing those of pharmacologic monotherapy.
Due to the ineffectiveness of current treatments, some OCD patients opt for psychosurgery procedures focusing on the alteration of brain structures believed to enable the disease process. One example is the Gamma Knife. In this procedure, specific brain targets are essentially burned by carefully aimed beams of radiation. Such surgeries have always been considered dangerous and thereby employed only in desperate cases. However, the precision of these treatments has improved over time and now produces better outcomes with less chance of serious complications.
Other options that use direct physical/electrical stimulation are Deep Brain Stimulation (DBS) and Vagus Nerve Stimulation (VNS). DBS is more invasive with a higher chance of complications. VNS is considered less risky and more easily reversed. Unfortunately, both of these options are expensive and still carry significant risks.
Ketamine therapy has been gaining momentum in treating severe mental health conditions. Its intranasal version (esketamine) has been recently approved by the FDA and EMA for treatment-resistant depression.
Most Ketamine-related studies use IV Ketamine infusions as opposed to esketamine inhalation. Many studies provide preliminary evidence of the safety and effectiveness of low-dose infusion therapy in treating a variety of mental illnesses. Trials addressing OCD cases, and other conditions, are limited but gaining in popularity as evidence emerges of Ketamine as an anti-obsessional intervention.
In the meantime, existing treatments for obsessive compulsive disorder are insufficient with many patients remaining severely impaired. On top of the ruminations and compulsions that come with the disorder, pharmaceutical therapy carries the usual side effects of anti-depressants and the regimen is difficult to discontinue.
For all of these reasons, OCD patients are in dire need of innovative adjunct forms of OCD therapy that improve functionality while curbing side effects. Such a combination of features would restore them to active participation in the workplace as well as in their family and friendships. Studies and trials looking at Ketamine infusions for OCD are welcome and promising news.
Since its discovery in 1962, Ketamine has been used as a dissociative anesthetic and a potent analgesic agent. However, after many small trials over the last decade, Ketamine has shown its capabilities in treating various mood and anxiety disorders like Depression and PTSD. Although the U.S Food and Drug Administration (FDA) has long since approved Ketamine as an anesthetic, these new findings bring hope to physicians in search of more efficacious OCD interventions.
Ketamine clinics currently administer low doses via infusion to lift low mood and lessen anxiety. Even treatment-resistant patients are seeing benefits. Optimism is growing about the power of these infusions to manifest as OCD solutions.
As their name suggests, Selective Serotonin Reuptake Inhibitors (SSRIs), act by inhibiting the reuptake of the serotonin, leaving more of the neurotransmitter in the synaptic clefts. Ketamine, on the other hand, doesn’t exert its effects through this mechanism.
Ketamine’s main mechanism is apparently apart from serotonin and other commonly selected neurotransmitters like norepinephrine and dopamine. Instead, Ketamine acts on N-methyl-D-aspartate (NMDA) receptors, regulating glutamate activity. This is significant because the glutamatergic system is thought to impact not only OCD symptoms but those of Depression and other mental health impediments. Regulatory abnormalities in the modulation of glutamate are linked to OCD and other behavioral health conditions. There is much more to learn about Ketamine’s relationship to the mechanisms underlying OCD. The good news is that Ketamine’s safety record permits trials and experimentation.
The potential for addiction is brought up as a concern in Ketamine’s use. However, the risk of abuse is unlikely in a controlled, medical setting. Unfortunately, because the public first heard of it as a recreational drug, that myth persists.
Regarding the procedure of Ketamine administration itself, k holes and other possible complications tend to be mild and pass quickly. If there is an emergent situation, clinics have the equipment to properly intervene.
With ketamine treatments, a patient’s situation may improve, allowing healthier social and workplace integration. Time will reveal IV Ketamine infusion therapy’s efficacy and limitations. Further research will provide more clarity regarding Ketamine action, benefits, and side effects.