Obsessive compulsive disorder (OCD) is a diagnosis that has been subject to frequent indiscriminate use outside the mental health field; however, The National Comorbidity Survey Replication estimates lifetime prevalence of OCD to be 2.3 percent in a 2010 study by Ruscio AM et al.
OCD is defined by the presence of obsessions, compulsions or both. Obsessions are defined as recurrent, persistent thoughts that are intrusive and unwanted. They can include things like fear of dirt and/or contamination by germs, fear of causing harm to another, fear of thinking evil thoughts, and the need (obsession) for order, symmetry, or exactness. Those suffering from OCD often attempt to ignore or suppress such thoughts but find it difficult to do so. Compulsions are defined as behaviors or mental acts (like counting or repeating words) that the person feels driven to perform in response to an obsession. These compulsions can be attempts at reducing anxiety/distress but are excessive. Often times, patients diagnosed with obsessive compulsive disorder have obsessions or compulsions that last on average at least one or more hours per day.
Patients with OCD frequently take selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine, fluoxetine, sertraline, or citalopram. Such SSRIs have been a boon to OCD patients, however response can take up to several months and dosages often have to be quite high, leading to increased risk of unpleasant side effects.
In 2013, Rodriguez et al. examined ketamine treatment for OCD patients who were not taking standard treatment with serotonin reuptake inhibitors. Although the study only involved 15 patients the design was randomized, double-blinded, placebo-controlled, and utilized patients with "near constant obsessions". Results from this study showed that 50% of the patients receiving ketamine met criteria for treatment response, while 0% of those who did not receive ketamine met this same criteria. In this case, “treatment response” meant a 35% reduction in OCD symptoms, including things like: distress from obsessive thoughts, time occupied by obsessive thoughts, amount of control over obsessive thoughts and effort put forth to resist obsessions amongst other OCD symptoms.
Perhaps more striking, however, is that Rodriguez et al. published some patient reactions to the remarkable effects of ketamine:
Psychotherapy, and in particular a type of cognitive behavioral therapy called exposure therapy, has always been considered a major and necessary treatment for OCD patients. After receiving ketamine treatments, exposure therapy may help OCD patients maximize their therapeutic gain. Given ketamine may help facilitate neuroplasticity, or the brain's ability to form new connections, patients often times find ketamine and therapy to be synergistic when used in conjunction.
As of now, a ketamine protocol similar to that used with major depressive disorder is used when treating OCD. This protocol has provided relief to many patients suffering with OCD. Further studies will be helpful in elucidating a standard protocol that may be more specific to obsessive-type and compulsive-type OCD. This may be sooner rather than later as multiple OCD related ketamine trials are currently underway.
If you or your loved one suffers from continued symptoms of Obsessive Compulsive Disorder following interventions from your psychiatrist, psychologist, or other mental health provider, give us a call at (561) 531-7818 or email us at firstname.lastname@example.org to learn more about how ketamine can help with OCD.