In recent years, psychedelics like ketamine have received a lot of buzz for their potential to help people with a range of mental health concerns like depression, post-traumatic stress disorder (PTSD), and anxiety. Ketamine clinics have also proliferated, offering infusions for a wide array of mental health issues including obsessive-compulsive disorder (OCD). The result is that more people with the disorder are curious about what the drug might be able to do for them.
But what are the facts, and should you really consider ketamine for OCD? Keep reading for the expert answers you need.
What is ketamine therapy?
Ketamine is considered an atypical psychedelic, not a “classical” one like psilocybin or MDMA. It’s classified as a “dissociative anesthetic”—causing people to feel detached from pain and their surroundings.
Ketamine has gone through many applications. For instance, it was used by the U.S. military as a “battlefield anesthetic” in the Vietnam War, and it’s still used as an anesthetic in emergency room settings.
Now, it’s entered the mental health field, with some saying it can be particularly helpful for those with depression for whom more conventional treatments have failed. While most antidepressants work by increasing serotonin levels, ketamine appears to impact a neurotransmitter called glutamate, which has a role in mood regulation.
But keep in mind ketamine’s standing: “With the exception of esketamine, a federally approved ketamine nasal spray for treatment-resistant depression, the psychiatric use of ketamine is unapproved and unregulated, though so-called off-label use of ketamine is not illegal,” the New York Times reported.
Can ketamine treat OCD?
Simply put, “there is no compelling evidence at this point for the efficacy of ketamine for OCD,” says Jamie Feusner, Chief Medical Officer at NOCD.
The FDA has not approved ketamine therapy for treatment, and its use remains off-label. This means that some clinicians may find it beneficial for certain patients, but there is still a lack of established guidelines for its use specifically in OCD. (Being off-label means every individual practitioner develops their own treatment protocol—there’s no standardization.) And studies are extremely limited. “There have been only two clinical trials published: both were open-label (not blinded or controlled, so they could be biased) and 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.
“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,” says NOCD therapist Tracie Ibrahim, LMFT, CST.
Exposure and response prevention (ERP) therapy is the exact opposite: It does have decades of clinical research backing its effectiveness, and it goes to the core of OCD, so you’ll learn tools that make daily living with the condition a lot easier. (Keep reading to learn more about ERP.)
Ketamine FAQ
It’s worth repeating: We don’t have enough evidence to suggest that ketamine therapy should be considered as a treatment for OCD. That said, you may still have questions about ketamine in general. Experts generally consider ketamine a safe medication, but there are caveats and things to be aware of.
Can you get addicted to ketamine?
Yes. Ketamine has the potential for abuse. Abuse of the drug may lead to moderate or low physical dependence or high psychological dependence.
Can you overdose on ketamine?
Yes. While ketamine is rarely lethal, it is possible to overdose on the drug, says the DEA. which can lead to unconsciousness and dangerously slowed breathing. In 2023, the death of actor Matthew Perry brought public attention to the potential dangers of ketamine misuse.
What else can happen if you take too much ketamine?
Increased blood pressure and paranoia are rare side effects that can happen when users take very high doses.
Should ketamine be taken at home?
No. Ketamine administration, when needed, should happen in a clinic or medical office. Patients typically receive the drug intravenously (IV) or via an intramuscular (IM) injection, and some may also use nasal sprays. During the session, individuals are monitored by healthcare professionals. After administering, patients are observed until they are stable enough to leave and dissociative effects subside.
What’s a k-hole?
People who take larger doses of ketamine may experience more severe, schizophrenia-like symptoms where perceptions are completely different from reality. These are often called “k-holes,” and they’re commonly linked to illicit use, where people may become non-communicative and unresponsive.
Who is not a good candidate for ketamine therapy?
Generally, ketamine should not be used in patients who have cardiovascular disease, severe liver disease, underlying psychiatric conditions that are associated with psychosis, as well as other medical conditions.
How much is ketamine therapy?
“Ketamine costs are extremely expensive if you have to pay out of pocket, and can cost $2000 or more per treatment visit,” says Ibrahim. “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.”
“Often, for coverage, insurance companies will call/consult with your psychiatrist,” Ibrahim says. “Your psychiatrist has to document that you have tried several medications and therapy and that those failed, in order to even be considered for partial coverage of ketamine treatment.”
What’s the best treatment for OCD?
A quick refresher: OCD is a chronic mental health condition; its two main symptoms are obsessions, or recurrent and intrusive thoughts, urges, feelings, sensations, or images that cause distress, and compulsions, or repetitive behaviors or mental acts done in an attempt to reduce anxiety or “neutralize” obsessive thoughts. Compulsions often work, but only temporarily, which is why a more lasting way of dealing with the disorder is needed.
Although it’s tempting to follow the buzz and explore experimental treatments, OCD is a condition that people suffer with for too long; in fact, it takes people with OCD an average of 14 to 17 years to receive a diagnosis and begin effective treatment. That’s why it’s so important to be aware of the fact ERP therapy remains the leading evidence-based approach for treating OCD.
This specialized therapy works to break the OCD cycle of obsessions and compulsions by exposing you to what triggers your intrusive thoughts, images, feelings, sensations, 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 stop doing compulsions and learn to 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.
On average, it can take about two months of ERP treatment to see a change in your symptoms.
“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. So why not continue and go with that as you’re working on things?”