Ketamine Treatment for Pediatric Refractory Obsessive: Five Open Label Cases

Area of Science:

• Psychiatry and Behavioral Sciences
• Pharmacology
• Clinical Trials

Background:

• First-line treatments for pediatric obsessive-compulsive disorder (OCD), including SSRIs and CBT, have limited effectiveness.
• Refractory OCD in adolescents necessitates exploration of novel therapeutic interventions.
• Intravenous (IV) ketamine presents a potential pharmacological avenue for treating OCD.

Purpose of the Study:

• To evaluate the feasibility and acceptability of IV ketamine infusions in adolescents with treatment-refractory OCD.
• To assess the preliminary efficacy of IV ketamine in reducing OCD symptom severity.
• To monitor for adverse events and tolerability of IV ketamine in this population.

Main Methods:

• A pilot clinical trial involving five adolescents diagnosed with OCD who had not responded to prior treatments.
• Participants received a single IV infusion of ketamine hydrochloride (0.5 mg/kg).
• Feasibility, acceptability, and preliminary efficacy were assessed using physiological measures, self-reports, and clinician ratings (including CY-BOCS) over a 2-week period.

Main Results:

• IV ketamine was well-tolerated, with no serious adverse events such as abnormal vital signs or suicidal ideation reported.
• Mild, transient dissociative symptoms were observed immediately post-infusion.
• A descriptive decrease in obsessive-compulsive symptom severity (CY-BOCS) was noted immediately after infusion, though not sustained over 14 days.

Conclusions:

• IV ketamine is a feasible and well-tolerated treatment option for adolescents with refractory OCD.
• The preliminary findings support further investigation into the efficacy of ketamine for adolescent OCD.
• Additional research is warranted to optimize dosing and duration for sustained symptom improvement.