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Ketamine is both a powerful anesthetic and a dangerous club drug.

Recent research indicates that it may also be what one expert describes as “among the most important discoveries in mood research over the last half century.”

This researcher was referring to ketamine’s promise as an antidepressant. Ketamine may also help people who suffer with severe symptoms of obsessive-compulsive disorder (OCD).

What Is Ketamine?

Ketamine was originally synthesized in 1962. The drug is often used as an anesthetic by doctors and veterinarians. When used in this manner for legitimate medical or veterinary purposes, it has proved to be both safe and effective.

Underscoring ketamine’s medical value, the World Health Organization (WHO) has included it in the Model List of Essential Medicines since the 1980s.

Unfortunately, ketamine has also become a popular (and dangerous) recreational substance.

Ketamine’s effects include dissociation. This means that the drug can alter a person’s visual and auditory perception, while also inducing a sense of detachment from one’s body and surroundings. These effects have made the drug an enticing choice for people who are seeking a certain type of illicit high.

Due to its popularity among people who attend music festivals and dance parties, ketamine is often included in the informal category of club drugs. Its use by some predators who surreptitiously give it to unsuspecting victims in order to incapacitate them has also earned ketamine a spot alongside rohypnol and GHB in the list of date-rape drugs.

A Brief Review of Ketamine & Depression

The first suggestions that ketamine could help people with depression surfaced in the late 1970s.

In a 2010 paper titled Taming the Ketamine Dragon, Edward F. Domino, M.D., recalled that a patient he was treating for drug addiction in the 1970s told him ketamine helped her more than her antidepressants did. However, Dr. Domino, wrote, his concerns about the dangerous effects of ketamine prevented him from conducting research into the drug’s effect on depression.

It would take until the mid-1990s before ketamine began to gain significant attention among mental health professionals for its potential as an antidepressant.

The first placebo-controlled, double-blinded trial of ketamine treatment for depression was published Feb. 15, 2000, in the journal Biological Psychiatry.

  • Over two days, seven subjects were given IV injections of either ketamine hydrochloride or a saline solution.
  • The study’s subjects did not know if they were receiving ketamine or saline.
  • The research team reported that the subjects who received ketamine experienced “significant improvement in depressive symptoms” within 72 hours after receiving the drug.

This was a small study, but its results were significant. Over the next 19 years, additional research confirmed and built on the findings of this initial report.

In 2019, the FDA approved the limited used of a version of ketamine called esketamine for people who have treatment-resistant depression. Esketamine is administered via a nasal spray. It can only be used in a doctor’s office or in another approved treatment location. This medication is not available for take-home use.

What Is Treatment-Resistant Depression?

Esketamine has been approved for people who have treatment-resistant depression. But this disorder doesn’t appear in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). So, how can a person know if they qualify for ketamine treatment?

As the term indicates, treatment-resistant depression is a depressive disorder with symptoms that have not been alleviated by prior professional care. But what constitutes an attempt at treatment – and how long does a person need to receive care before determining that it didn’t work?

In a 2020 article in the journal Neuropsychiatric Disease and Treatment, a team led by Dr. Daphne Voineskos of the University of Toronto noted that various professionals use different criteria to define treatment-resistant depression.

At the moment, Voineskos and her team wrote, the general consensus is that a person must have tried two different antidepressants without adequate response. Voineskos also noted that “adequate response” can also be open to multiple interpretations.

Johns Hopkins Medicine defines treatment-related depression as follows:

  • The patient has tried two different antidepressants.
  • The patient used each antidepressant for a minimum of six weeks.
  • The medication did not eliminate symptoms or result in “at least a 50% improvement in mood.”

If you have any questions about treatment-related depression or your eligibility for ketamine treatment, consult with your doctor or contact Crownview Psychiatric Institute.

Ketamine & OCD: Promising Early Results

As reports of ketamine’s antidepressant properties began to spread, researchers began to investigate the drug’s ability to help people with other mental health concerns, including obsessive compulsive disorder (OCD).

According to an Aug. 21, 2017, article in Stanford Medicine Magazine, the first clinical trial for ketamine as an OCD treatment took place in 2012.

This trial involved 15 adults with OCD who had “near constant” obsessions. Each subject received two IV infusions (one of a saline solution, one of ketamine) one week apart. The subjects did not know which infusion they were receiving.

Some participants in that trial began to experience a decrease in OCD symptoms within 30 minutes of receiving the ketamine infusion. When these participants were assessed a week after receiving ketamine, their OCD symptoms had not yet returned.

“I tried to have OCD thoughts, but I couldn’t,” one study subject told the researchers.

“This study indicates that ketamine can have rapid anti-obsessional effects, and these effects can persist for at least one week in some patients with OCD,” wrote Carolyn Rodriguez, MD, PhD, who led the trial.

Ketamine & OCD: Concerns About Diminishing Effectiveness

The clinical trial that Dr. Rodriguez led documented two important characteristics of ketamine treatment for OCD:

  • Ketamine can lead to a rapid and dramatic reduction in OCD symptoms.
  • The effects of ketamine treatment for OCD are relatively short-lived.

Researchers have continued to investigate ketamine’s ability to provide long-term benefits for people with OCD.

A 2012 study in the journal Biological Psychiatry echoed earlier findings about ketamine, OCD, and depression. This study involved 10 subjects. All 10 subjects had OCD. Seven subjects also had co-occurring depression.

The study’s lead author, Dr. Michael H. Bloch of Yale University, reported the following:

  • Four patients who had co-occurring depression experienced an improvement in depression symptoms within first three days of receiving ketamine.
  • Ketamine’s ability to reduce symptoms of depression was significantly greater than the drug’s effects on symptoms of OCD.
  • Ketamine’s effects on OCD symptoms neither persisted nor progressed once the initial impact began to dissipate.

Extending Ketamine’s Effects on OCD

Four years after the Bloch team’s study, a letter to the editor of the Journal of Clinical Psychiatry suggested that exposure-based cognitive behavioral therapy (CBT) may be able to extend the effects of ketamine treatment for OCD.

This letter was written by a team that was led by Dr. Carolyn Rodriguez, who ran the initial ketamine trial in 2012. The letter described an open-label study involving 10 subjects who had “near-constant intrusive obsessions,” which Dr. Rodriguez defined as lasting for more than eight hours each day.

Features of the study:

  • Each subject received one 40-minute ketamine infusion.
  • The subjects participated in 10 one-hour exposure therapy sessions over a two-week period following their ketamine infusion.

Dr. Rodriguez’s team reported the following results:

  • Nine of the subjects completed the infusion. Of this group, eight subjects experienced a rapid easing of OCD symptoms. This effect lasted up to 230 minutes (or just less than four hours).
  • The eight subjects who had the rapid symptom reduction completed all 10 exposure sessions.
  • For four weeks after receiving the ketamine infusion, the eight subjects who completed the exposure sessions had less severe symptoms than they did prior to the ketamine infusion. However, after week two, their symptoms begin to increase.

“The data suggest that a brief course of CBT may help some individuals maintain the improvement they experienced from ketamine,” Dr. Rodriguez wrote. “[H]owever, this needs to be formally tested in a randomized controlled trial to determine whether the improvement seen after two weeks of CBT is due to the addition of CBT, or whether the effects of ketamine persist longer in some than previously described.”

Find Treatment for OCD & Depression

If you or someone that you care about have been experiencing severe symptoms of OCD and/or depression, Crownview Psychiatric Institute may be able to help. Our center specializes is caring for adults whose lives have been disrupted by acute symptoms of complex mental health concerns. Contact us today to learn more about our programs, services, and admissions policies.