In recent years, psychedelics like ketamine have received a lot of buzz for their potential to help with mental health conditions like depression, post-traumatic stress disorder (PTSD), and anxiety. Ketamine clinics have become more common—offering infusions for a wide range of mental health concerns including obsessive-compulsive disorder (OCD).
If you have OCD, it’s natural to be curious about all potential treatment options—especially if traditional forms of treatment haven’t provided you with quick results. So, you might be curious about what ketamine could do for you. But, what’s the science behind how ketamine impacts OCD? And, are there any potential dangers to considering this experimental treatment?
Keep reading for expert answers.
What is ketamine therapy?
Ketamine is classified as a “dissociative anesthetic,” which means it’s a drug that can cause you to feel detached from your surroundings, as well as emotional or physical pain you may be experiencing. While ketamine is often grouped together with “classic” psychedelics, like psilocybin or LSD, it is considered a non-classic psychedelic, because it doesn’t interact much with serotonin 2A receptors in the body. Instead, it targets neurotransmitters like dopamine and glutamate.
Ketamine was used by the U.S. as a “battlefield anesthetic” during the Vietnam War, and is still used as an anesthetic in emergency room settings. Now, some researchers and clinicians believe it can be helpful for people with PTSD, depression, and other mental health conditions who haven’t experienced relief from conventional treatments. Ketamine’s effects are typically felt quickly, unlike antidepressants which can take weeks to months to kick in.
Ketamine therapy is usually administered intravenously (IV) or via an intramuscular (IM) injection, but some people may also use nasal sprays. During the session, people undergoing ketamine therapy are monitored by healthcare professionals. After administering, you’re observed until you are stable enough to leave, and dissociative effects have subsided.
Is ketamine safe?
While researchers and clinicians are exploring ketamine’s psychiatric use, it has not been FDA approved for these purposes (with the exception of one nasal spray for treatment resistant depression). Most ketamine for therapeutic purposes remains unregulated, even though off-label use is not illegal.
Experts generally consider ketamine a safe medication, but there are some potential safety concerns to be aware of:
- Dependency: Ketamine has the potential to lead to substance use disorder, which may result in moderate or low physical dependence, or high psychological dependence.
- Overdoses and k-holes: While ketamine is rarely lethal, it is possible to overdose on the drug, according to the Drug Enforcement Agency, which can result in unconsciousness and dangerously slowed breathing. Larger doses of ketamine can also result in “k-holes”—experiences characterized by severe, schizophrenia-like symptoms, including unresponsiveness, increased blood pressure, paranoia, and delusions.
- The importance of supervision: Experts advise that ketamine administration should happen in a clinic or medical office, rather than at home. Healthcare providers who are trained to administer ketamine understand the correct dosages and how to respond to emergencies.
- Limitations: Generally, ketamine should not be used by people who have cardiovascular disease, severe liver disease, or underlying psychiatric conditions that are associated with psychosis.
- Barriers to care: A single ketamine infusion can cost hundreds of dollars, and people typically require six to eight infusions. Most insurance companies don’t cover ketamine-assisted therapy. “I do not think ketamine treatment is accessible to most people due to costs, limited insurance coverage, and the fact that not a lot of clinics offer it,” says NOCD chief compliance officer Tracie Ibrahim, LMFT, CST.
Does ketamine work for OCD?
The FDA has not approved ketamine therapy for OCD treatment, and its use remains off-label. This means that some clinicians may find it beneficial for certain people, but there is still a lack of established guidelines for its use for OCD, specifically. (Being off-label means that every individual practitioner develops their own treatment protocol, and there’s no standardization.)
What does research say about using ketamine for OCD?
Simply put, “there is no compelling evidence at this point for the efficacy of ketamine for OCD,” according to Jamie Feusner, Chief Medical Officer at NOCD.
Studies on ketamine treatment for OCD are still extremely limited. “There have been only two clinical trials published: both were open-label (not blinded or controlled, so they could be biased) and were very small,” explains Feusner. For instance, one 2013 study published in Neuropsychopharmacology found that ketamine infusion improved OCD symptoms compared to the placebo, but it involved only 15 patients.
Some people who have experienced benefits from ketamine treatment for OCD say the drug causes a kind of “ego death” where you lose your sense of self or identity. While this can be a scary experience, some report that it allowed them to more easily release the hold OCD previously had on them.
However, it’s important to understand that even in instances where ketamine improves symptoms, any relief may be temporary. “Ketamine may decrease symptom intensity a bit, but it will not help in a significant way—and it won’t teach you how to survive the day to day,” Ibrahim says.
Ketamine alone will not resolve your OCD, and the drug’s effects usually last one to three hours, according to Mindbloom, a ketamine-assisted telemedicine company.
Instead of thinking as ketamine as a cure-all for OCD, researchers like Uma Chatterjee, M.S., MHPS, put it this way: “ We’re looking at it as a way to expand our toolkit for different treatment options, and especially to address the people who have been labeled as treatment-resistant.”
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
What is the best treatment for OCD?
Unlike ketamine, exposure and response prevention (ERP) therapy does have decades of clinical research supporting its efficacy for treating OCD, specifically. Although it’s tempting to follow the buzz and explore experimental treatments, delaying effective treatment can make OCD symptoms worse. That’s why it’s so important to be aware that ERP therapy remains the leading evidence-based approach for treating OCD.
This specialized form of cognitive-behavioral therapy works to break the OCD cycle of obsessions and compulsions by exposing you to what triggers your intrusive thoughts, sensations, images, feelings, or urges. The second and perhaps most crucial part of ERP focuses on response prevention techniques that teach you how to resist engaging in the compulsions that make OCD worse over time.
A therapist specializing in ERP will guide you through various exercises that will help you learn to stop compulsions and accept the uncertainty and doubt that obsessions can bring. Over time, your brain learns that the fears prompted by your obsessions are not actual threats, making these thoughts feel less intense and frequent with time.
“You always want to start with ERP,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD. “Some people hear about certain treatments online and think, that must mean that’s the best, new option, but just because something is new doesn’t mean it’s better. We know that ERP works and that it’s good.”
Bottom line
Ketamine therapy is a new and experimental potential treatment for OCD, which isn’t FDA approved, and has no standardized treatment protocol. Some people with OCD report that ketamine has provided relief from symptoms, but experts say these benefits may only be temporary—and it is by no means a cure-all. Experts continue to point to ERP therapy as the most evidence-based and effective treatment for OCD.