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

Abstract

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.

• Authors: Michael H Bloch, Suzanne Wasylink, Angeli Landeros-Weisenberger, Kaitlyn E Panza, Eileen Billingslea, James F Leckman, John H Krystal, Zubin Bhagwagar, Gerard Sanacora, Christopher Pittenger
• Journal: Biological psychiatry (Biol Psychiatry) Vol. 72 Issue 11 Pg. 964-70 (Dec 01 2012) ISSN: 1873-2402 [Electronic] United States
• PMID: 22784486 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antidepressive Agents
• Excitatory Amino Acid Antagonists
• Ketamine

Topics

• Adolescent
• Adult
• Antidepressive Agents (therapeutic use)
• Depression (drug therapy)
• Excitatory Amino Acid Antagonists (therapeutic use)
• Female
• Humans
• Ketamine (therapeutic use)
• Male
• Middle Aged
• Obsessive-Compulsive Disorder (drug therapy)
• Patient Selection
• Psychiatric Status Rating Scales
• Treatment Outcome