Remedies for Treatment-Resistant OCD

Obsessive-Compulsive Disorder (OCD) is a serious mental health disorder that has serious consequences when left untreated. Due to portrayals in popular media, the disorder is also often misunderstood as a personality quirk. However, anyone who is impacted by OCD knows the disorder is much more than that. 

People who have OCD are ten times more likely to complete suicide than the average person. This may be due to the severity of the symptoms and difficulty in finding adequate treatment. Unfortunately, OCD is a particularly difficult disorder to treat, leaving many patients with treatment-resistant OCD. With data like this, it’s clear that more needs to be done to give effective treatment options to patients with this disorder.

What Is Treatment-Resistant OCD?

In the United States, about 1 in 40 adults and one percent of children live with OCD. When these patients seek treatment, the first-line approach is often a combination of antidepressant medications and Cognitive Behavioral Therapy (CBT). This treatment plan works well for about half of patients with OCD.

The other half of patients with OCD either only see a slight improvement in symptoms or experience no improvement at all with first-line treatments. Until recent years, there have not been many other options for patients with OCD. They may try different types of antidepressants or go to new therapists, but many people still experience severe symptoms. These patients have what is known as treatment-resistant or treatment-refractory OCD.

Why First-Line OCD Treatments May Fall Short

To understand which patients need an alternative treatment, it’s important to get to the bottom of why first-line treatments don’t work for so many patients. In some cases, there is a comorbid disorder or a wrong diagnosis to blame. For example, someone who has OCD and substance abuse disorder may not recover from OCD until they address the other issues too. Furthermore, obsessions may be caused by delusions and paranoia from a different disorder altogether. 

Even if a person is correctly diagnosed and has treated comorbid disorders, first-line treatments can fail. Both conventional medications and CBT take several months of treatment before patients see results. Furthermore, CBT is particularly uncomfortable for patients with OCD because it often involves exposure therapy. OCD patients also need traditional antidepressants in high doses. Not all patients can tolerate these intense treatments without some relief. 

Combining First-Line Treatments with Ketamine

When the United States Food and Drug Administration (FDA) approved a related compound, esketamine, for treatment-resistant depression, many researchers became interested in the substance’s effect on OCD. Although the research on OCD and ketamine is new and needs further testing, early results are promising. 

In one of the first studies on ketamine and treatment-resistant OCD, patients saw an average of a 35 percent decrease in symptoms after just one week of intranasal (IN) ketamine treatments. Patients described it as a vacation from OCD and as if a weight was lifted from them. Long-term studies are currently underway for ketamine and OCD. Although the results of the studies are not yet available, researchers say it looks promising. 

Ketamine works differently from other antidepressants for OCD. Instead of affecting the hormone known as serotonin, ketamine affects glutamate. Perhaps most importantly, ketamine offers quick relief from the severe symptoms of OCD. When the intensity of those symptoms are turned down, patients are better able to engage in CBT. It’s important to note that the FDA has not approved ketamine for the treatment of OCD, so it must be used off-label.

At Actify, we offer other OCD treatments including Esketamine nasal spray, TMS (also both off-label), and cognitive behavioral therapy. With this holistic approach, we can help patients find a treatment plan that works well for their needs. If you’re struggling with treatment-resistant OCD, contact Actify today to meet with a psychiatrist near you.