Ketamine is not FDA Approved for treatment of OCD (Obsessive Compulsive Disorder)

OCD (Obsessive Compulsive Disorder) usually is accompanied by depressive symptoms often severe Depression.

This can make treatment more difficult due to impaired concentration and reduced motivation.

The possibility of using Ketamine treatment for OCD Is an active area of investigation.

303. Biol Psychiatry. 2012 Dec 1;72(11):964-70. doi: 10.1016/j.biopsych.2012.05.028.

Epub 2012 Jul 10.

Effects of ketamine in treatment-refractory obsessive-compulsive disorder.

Bloch MH(1), Wasylink S, Landeros-Weisenberger A, Panza KE, Billingslea E,
Leckman JF, Krystal JH, Bhagwagar Z, Sanacora G, Pittenger C.

Author information:
(1)Yale Child Study Center, Yale University School of Medicine, New Haven,
Connecticut, USA. michael.bloch@yale.edu

BACKGROUND: Treatments for obsessive-compulsive disorder (OCD) usually lead to
incomplete symptom relief and take a long-time to reach full effect. Convergent
evidence suggests that glutamate abnormalities contribute to the pathogenesis of
OCD. Ketamine is a potent noncompetitive antagonist of the N-methyl-D-aspartate
glutamate receptor. Trials have reported rapid antidepressant effects after
low-dose ketamine infusion.
METHODS: We conducted an open-label trial of ketamine (.5 mg/kg IV over 40 min)
in 10 subjects with treatment-refractory OCD. Response was defined as >35%
improvement in OCD symptoms and >50% improvement in depression symptoms from
baseline at any time between 1 and 3 days after infusion.
RESULTS: None of 10 subjects experienced a response in OCD symptoms in the first
3 days after ketamine. Four of seven patients with comorbid depression
experienced an antidepressant response to ketamine in the first 3 days after
infusion. Both OCD and depression symptoms demonstrated a statistically
significant improvement in the first 3 days after infusion compared with
baseline, but the OCD response was <12%. The percentage reduction in depressive
symptoms in the first 3 days after ketamine infusion was significantly greater
than the reduction in OCD symptoms.
CONCLUSIONS: Ketamine effects on OCD symptoms, in contrast to depressive
symptoms, did not seem to persist or progress after the acute effects of ketamine
had dissipated.

PMCID: PMC3667652
PMID: 22784486 [PubMed - indexed for MEDLINE]

262. J Psychopharmacol. 2013 Jul;27(7):651-4. doi: 10.1177/0269881113486718. Epub 2013
May 15.

Two cases of delayed-onset suicidal ideation, dysphoria and anxiety after
ketamine infusion in patients with obsessive-compulsive disorder and a history of
major depressive disorder.

Niciu MJ(1), Grunschel BD, Corlett PR, Pittenger C, Bloch MH.

Author information:
(1)Yale University, Department of Psychiatry/Connecticut Mental Health Center
(CMHC), Clinical Neuroscience Research Unit (CNRU), New Haven, Connecticut, USA.
mark.niciu@nih.gov

Ketamine is a non-competitive N-methyl-D-aspartate receptor antagonist that is
Food and Drug Administration-approved in the United States for anesthesia due to
its sedative effects with low risk of severe respiratory depression.
Subanesthetic dose intravenous ketamine has rapidly acting antidepressant effects
in treatment-resistant unipolar and bipolar depression. We recently reported an
open-label trial of ketamine in 10 subjects with treatment-refractory
obsessive-compulsive disorder, seven of whom had active comorbid depression.
Although ketamine had no sustained anti-obsessive effect, four of the seven
subjects with comorbid depression experienced an acute antidepressant effect.
However, we unexpectedly observed delayed-onset dysphoria, worsening anxiety and
suicidal thinking in two of the three subjects with obsessive-compulsive disorder
and extensive psychiatric comorbidity but minimal depressive symptoms at the
start of infusion. The implications of these adverse neuropsychiatric effects in
two patients with similar psychiatric comorbidity are discussed. We conclude that
there remains insufficient data on therapeutic ketamine in the presence of
comorbid psychiatric disorders to promote its off-label use in a non-research
milieu.

PMID: 23676198 [PubMed - indexed for MEDLINE]