Title & Introduction
- Paper title: Ketamine for Treatment-Resistant Obsessive-Compulsive Disorder: Double-Blind, Active-Controlled Crossover Study
- Published In: Journal of Psychopharmacology, 2024
- Authors: Ben Beaglehole, Paul Glue, Shona Neehoff, Shabah Shadli, Neil McNaughton, Bridget Kimber, Chrissie Muirhead, Aroha de Bie, Rachel Day-Brown, Natalie J Hughes-Medlicott
- Objective: To assess the efficacy and tolerability of intramuscular ketamine in adults with severe treatment-resistant obsessive-compulsive disorder (OCD).
- Importance: With limited effective treatments for OCD, especially for treatment-resistant cases, this study explores the potential of ketamine as a rapid-acting alternative to traditional methods.
Summary & Takeaways
Key Takeaway: Ketamine, particularly at a 0.5 mg/kg intramuscular dose, shows promise as a rapid-acting treatment for treatment-resistant OCD. Its effects peak within hours and last for several days, offering a potential alternative to traditional therapies that require weeks to take effect.
Practical Applications:
- The study suggests ketamine could be used as an adjunct treatment for severe OCD, particularly in cases unresponsive to standard interventions.
- Future research should explore repeated or longer-term dosing strategies, potentially using oral or intravenous formulations, to prolong benefits and improve tolerability.
Key Background Information
Context: OCD affects 0.5%-3% of the population and severely impairs quality of life. Conventional treatments like antidepressants and cognitive-behavioral therapy (CBT) often take weeks to show effects, and approximately 25% of patients do not respond to current options.
Hypothesis: Ketamine, an NMDA receptor antagonist with demonstrated efficacy in treatment-resistant depression, may offer rapid and significant symptom relief for OCD.
Key Findings
Primary Outcomes:
- Ketamine significantly reduced OCD symptoms compared to fentanyl.
- Greatest reductions observed at 1–2 hours post-dose, with effects sustained for up to 168 hours.
- Y-BOCS reductions:
- 0.5 mg/kg ketamine: 60% responders (≥50% reduction).
- 1.0 mg/kg ketamine: 18% responders.
- Fentanyl: 10% responders.
Secondary Outcomes:
- Dissociative symptoms were dose-dependent, peaking at 15–30 minutes after ketamine administration.
- Cardiovascular changes (e.g., blood pressure fluctuations) normalized within an hour.
Interpretation & Implications
Conclusion: Ketamine demonstrated rapid, dose-dependent efficacy in reducing OCD symptoms, especially at the 0.5 mg/kg dose, which was better tolerated than the higher dose.
Implications: This study supports ketamine’s potential as a treatment for refractory OCD but highlights the need for further research to determine optimal dosing and evaluate long-term effects.
Limitations:
- Small sample size (n=12).
- High dissociative symptoms at higher doses.
- Short duration of benefit (approximately 1 week).
- Challenges in maintaining blinding.
Researchers & Publication
- Study URL: https://doi.org/10.1177/02698811241301215
- Publication: Journal of Psychopharmacology, 2024
- Authors: Ben Beaglehole, Paul Glue, Shona Neehoff, Shabah Shadli, Neil McNaughton, Bridget Kimber, Chrissie Muirhead, Aroha de Bie, Rachel Day-Brown, Natalie J Hughes-Medlicott
