Ketamine for OCD, Too?

I’ve written in the past about the use of a pharmaceutical version of the drug ketamine (known as the party drug, “Special K”) in studies with depression and with bipolar disorder. Recently, I learned researchers have published a new study looking at the impact of ketamine on obsessive compulsive disorder (OCD).

I was on the phone with someone interested in OCD treatment, and she mentioned she had read some promising work at Yale about an experimental treatment that involved increasing glutamate levels in people with OCD. Glutamate is a neurotransmitter in the brain. Ketamine affects NMDA, an important receptor for glutamate, leading to lower levels of glutamate in the brain. I told the caller I wasn’t familiar with this line of research, and she kindly sent me a few links, including the one below.

The IOCDF article
The International OCD Foundation (IOCDF) has an article on their website about the potential role of glutamate in understanding OCD, under the subheading, “Cutting Edge Research on New Medication Options.” It’s written by three doctors associated with Yale University. The authors summarize some research finding higher levels of glutamate in the brain in people with OCD. Although they acknowledge important caveats about what is known about glutamate so far, the authors end the article with pointing to ketamine as a possible treatment for OCD.

The article is reasonably balanced, but at the time it was written, there was no published research on the use of ketamine in people with OCD. A study from 2012 suggests these speculations may have been overly optimistic.

A 2012 research study
I haven’t been able to track down a copy of the full article, so my comments are taken strictly from the abstract. Two of three authors from the IOCDF article are authors on the study. The details are a little unclear but the take-away message is pretty explicit:

“Ketamine effects on OCD symptoms…did not seem to persist or progress after the acute effects of ketamine had dissipated.”

It appears that the effect of ketamine on OCD was very small, and it didn’t last very long. It looks like the enthusiasm in the IOCDF article could use some updating.

Some concluding thoughts
I’d like to be clear that I think the authors of the IOCDF articles are well-intentioned, honest, and excellent researchers. What’s important to keep in mind is that the history of science is littered with ideas that seemed sound or were based on preliminary research, but which were disappointing when studied through controlled research.

As I’ve noted in my other writings on ketamine, I don’t object to ketamine being studied; however, I think researchers should be more cautious about their enthusiasm when talking to the public. Science is a slow progress of trial-and-error, and truly revolutionary treatments are few and far between. Ketamine may yet emerge as useful for depression, but if this study is any indication, its role for OCD doesn’t look very promising.

That said, there’s some exciting research on improving psychotherapeutic approaches for OCD. Cognitive behavioral therapy isn’t as exciting as the promise of a fast-acting drug, but it is effective and the best thing we have for OCD, particularly exposure therapy, something I’ve written about in our therapist blog.


Book Review: OCD, A Guide for the Newly Diagnosed

Although OCD is commonly used to describe someone who is overly tidy, this stereotype doesn’t capture the common struggles of someone with obsessive-compulsive disorder. Perhaps as a consequence of stereotypes such as this, many people with OCD suffer for years — knowing that something is wrong but being uncertain how to even describe what they’re going through.

A new book came out this year that offers guidance for those with OCD. The book is called OCD: A Guide for the Newly Diagnosed. It’s written by psychologist Michael Tompkins, PhD, who works at the San Francisco Bay Area for Cognitive Therapy and is a professor at the University of California, Berkeley.

The book is not a self-help book in the sense that it offers strategies for managing OCD. Instead it’s an information guide that covers a range of helpful topics such as effective treatments (e.g., exposure with response prevention, medications), how to interview potential providers, and even how and when to request work or school accommodations.

What impressed me most about this book was its concise readability. The book is about the size of a short paperback novel, and I easily read through it within a few hours across a couple evenings. It’s clear the author cares deeply about helping people with OCD, and he’s able to convey his compassion in a writing style that’s precise, yet warm and empathic.

If you or anyone you know struggle with OCD, I highly recommend you pick OCD: A Guide for the Newly Diagnosed. It’s also a great resource for therapists, packed with up-to-date information.