Ketamine in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review

Summary & key facts

Researchers looked at all available studies testing ketamine for obsessive-compulsive disorder. They found nine studies of different types. Some results suggest ketamine can reduce symptoms quickly and that people usually tolerate it, but the effects were inconsistent and most studies gave just a single intravenous dose of the common mixed form of ketamine. There is not enough good evidence yet to know which form, dose, or schedule works best, or whether combining ketamine with therapy helps. The authors say bigger, well-controlled trials with multiple sessions and different ways of giving the drug are needed before we can know how useful ketamine is for OCD.

Key facts:

• This paper is a systematic review that searched major medical databases and found nine studies testing ketamine for obsessive-compulsive disorder.
• The nine studies included three carefully controlled trials, three case reports, two open-label trials, and one chart review.
• Most of the main studies used a single intravenous session of the mixed (racemic) form of ketamine.
• Some studies reported a fast reduction in OCD symptoms after ketamine and generally good tolerability, meaning side effects were not severe for most people in those studies.
• The results across studies were inconsistent or erratic, so findings did not point to a clear, reliable benefit for everyone.
• Researchers do not yet know whether the mixed form, the S-form, or the R-form of ketamine works best for OCD.
• Only a small amount of evidence looked at combining ketamine with psychotherapy, and those hints of benefit are too limited to be sure.
• The review concludes that larger, double-blind placebo-controlled trials are needed. Those trials should test different ketamine types, ways of giving it, and multiple sessions to learn what really helps people with OCD.

Abstract

INTRODUCTION: First-line treatment for obsessive-compulsive disorder (OCD) includes exposure and response prevention behavioral therapy and serotonin reuptake inhibitors, particularly in combination. New and more effective treatments are needed, give that recent studies suggest that glutamatergic neurotransmission contributes to the pathophysiology of the disorder. In these circumstances, ketamine, as a potent N-methyl-D-aspartate receptor antagonist and glutamate modulator, offers alternative possibilities for OCD treatment. METHODS: This systematic review aims to investigate the effects of ketamine in OCD, following the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols (PRISMA-P). Searches were carried out using the PubMed/MEDLINE, Embase, and PsycINFO databases. RESULTS: Nine articles were included, of which three were randomized controlled trials, three case reports, two open-label trials, and one a retrospective chart review. Reported data have shown a potential for fast onset of action and good tolerability of ketamine for OCD, even though the principal studies used only single-session racemic ketamine treatments, administered intravenously, and the results have been erratic. In addition, none of the available evidence demonstrates whether racemic ketamine, S-ketamine, or R-ketamine has the best efficacy in controlling OCD symptoms, and only sparse evidence suggests that a combination of ketamine and psychotherapy could benefit patients with OCD. CONCLUSION: In order to advance clinical practice regarding the use of ketamine in treating OCD, future randomized, double-blind, placebo-controlled trials are required. These trials need to use larger samples to explore ketamine and its enantiomers, with different methods of administration, multiple sessions, and appropriate washout periods.

Topics

Body Image and Dysmorphia Studies Obsessive-Compulsive Spectrum Disorders Treatment of Major Depression

Categories

Clinical Psychology Psychology Social Sciences

Tags

Adverse effect Alternative medicine Clinical trial Dissociative Internal medicine Ketamine Law Medicine MEDLINE Meta-analysis Pathology Pharmacology Placebo Political science Psychiatry Psychology PsycINFO Randomized controlled trial Systematic review Tolerability

Substances

Ketamine

Conditions & symptoms

Obsessive-Compulsive Disorder Anxiety or worry