Taking the Obsessions Out of Obsessive-Compulsive Disorder
About the Author Dr. Steve Levine is a board-certified psychiatrist internationally recognized for his contributions to advancements in mental health care. Though he is a psychiatrist who places great emphasis on the importance of psychotherapy, medication is often a necessary component of treatment, and he was dissatisfied with the relatively ineffective available options with burdensome side effects. Dr. Levine pioneered a protocol for the clinical use of ketamine infusions, has directly supervised many thousands of infusions and has helped establish similar programs across the country and around the world.
What is OCD?
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.
How is OCD treated?
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.
Can Ketamine Help Treat OCD?
Perhaps more striking, however, is that Rodriguez et al. published some patient reactions to the remarkable effects of Ketamine. I will quote them unmodified below:
- “I feel as if the weight of OCD has been lifted… I want to feel this way forever”
- “I feel like someone is giving me an explanation [for my OCD]”
- “I don’t have any intrusive thoughts. I was laughing when you couldn’t find the key, which normally is a trigger for me. This is amazing, unbelievable. This is right out of a movie”
- “I tried to have OCD thoughts, but I couldn’t”
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 through a natural process called neuroplasticity. Given ketamine may help facilitate neuroplasticity, 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 888-566-8774 or email us at firstname.lastname@example.org to learn more about how ketamine can help with OCD.