The term Obsessive Compulsive Disorder (OCD) has much deeper meaning than many of us may realize.  It is not uncommon to hear it casually used in daily conversation, often as a joke.  True OCD patients suffer out of proportion to what the public can see or acknowledge. This mental health disease traps those afflicted in a vicious cycle in their minds. It is distinctly different than perfectionism, which is a personal philosophy that rejects anything less that perfect.

The obsession is an intrusive thought, idea, impulse, or image that repeatedly enters the mind and causes anxiety. These thoughts can range from fear of aggression, contamination, repeated checking, and a host of other intrusive worries that do not go away.  The obsession then drives the compulsion, which is what the person has to do or act on in order to relieve the anxiety. Unfortunately, the relief is so short lived, the compulsion must be repeated over and over, in response to the brain repeating the obsession. This cycle can be so debilitating that some can not leave their house, end up hospitalized, or have suicidal thoughts and/or attempts.

Two primary approaches to treatment of OCD are cognitive behavioral therapy (CBT) and oral medications. CBT is considered the gold standard for treatment and should include exposure and response prevention, where patients confront their fears and stop their response behaviors.  Medications commonly used include SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine or sertraline. Other classes of medication, such as antipsychotics or benzodiazepines may be included.  They often take time, months, however, and that is where quick acting medication may be helpful in the interim.

Ketamine is popularly known in recent years for easing treatment resistant depression by affecting the glutamate levels in our nervous system.  OCD patients also have glutamate abnormalities. Carolyn Rodriguez, M.D., Ph.D. from Stanford University is currently running a 5 year study researching how ketamine helps those with OCD.(1)  She started this trial because her initial research showed significant relief of symptoms for some of her patients. Other providers, such as Steven L. Mandel, M.D., started seeing their ketamine treated depressive patients also get relief of coexisting OCD symptoms.(2) His and other ketamine clinics are now including OCD patients.

This simplified overview of OCD and treatment options will vary based on symptom severity and any associated mood disorders.  Ketamine can be a boost that gets someone to go to their therapy appointments.  It may give moments of clarity where someone realizes they will be fine without performing their compulsions. And, it can be of help to ease suicidal thoughts and start the healing process.

~ Cindy Van Praag, MD

https://tonic.vice.com/en_us/article/j55gxx/ketamine-is-showing-early-success-with-treating-ocd
Steven L Mandel M.D., Ketamine Clinics of Los Angeles, https://www.ketamineclinics.com