Ketamine for treatment-resistant obsessive-compulsive disorder: Double-blind active-controlled crossover study

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Neuroscience

Background:

• Obsessive-Compulsive Disorder (OCD) presents significant challenges in treatment-resistant cases.
• Exploring novel therapeutic agents is crucial for improving patient outcomes.

Purpose of the Study:

• To compare the efficacy and tolerability of intramuscular (IM) ketamine versus IM fentanyl in patients with treatment-refractory OCD.
• To assess the dose-response relationship of ketamine in this patient population.

Main Methods:

• A randomized, double-blind, psychoactive-controlled study involving single doses of ketamine (0.5 mg/kg or 1.0 mg/kg) or fentanyl (50 µg).
• Participants received ondansetron for nausea prophylaxis.
• The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was the primary efficacy measure, and the Clinician-Administered Dissociative States Scale (CADSS) assessed tolerability.

Main Results:

• Reductions in Y-BOCS scores were significantly greater and dose-related with ketamine compared to fentanyl (p=0.031).
• Symptom improvement peaked at 1-2 hours post-administration and persisted up to 168 hours.
• Ketamine was associated with transient dissociative and cardiovascular effects.

Conclusions:

• Preliminary evidence supports the efficacy and tolerability of IM ketamine for outpatient treatment of OCD.
• Further research is needed to determine optimal dosing and long-term effectiveness.
• These findings offer hope for a population with limited treatment options.