Ketamine and Psychedelics for Obsessive-Compulsive Disorder by Christopher Pittenger, MD, PhD
Ketamine and psychedelics are being actively researched for OCD, and thus are currently classified as “experimental.” Early results of this research show promise, but they are not considered a treatment for OCD and should only take place within controlled research settings. This article will take you through everything we do and do not know so far about ketamine and psychedelics for OCD.
Q: I’ve read about ketamine treatment for depression. Does it also work in OCD?
A: Ketamine is an anesthetic drug that works on the brain’s glutamate system. Intravenous (IV) infusions of ketamine were found in the late 1990s to have surprisingly rapid antidepressant effects in many people, and iV ketamine is now increasingly widely used as a treatment for severe cases of depression and suicidality. The effect generally doesn’t last, and so repeated treatments may be necessary.
Because some antidepressant drugs work for OCD, and because there is some evidence that the neurotransmitter glutamate is out of balance in OCD, researchers have studied whether ketamine can work for OCD over the past 15 years.Results are mixed. There is some evidence from small randomized, placebo-controlled trials that it can be helpful in people with OCD who are on no medications and don’t have any other significant psychiatric diagnoses. Studies that have looked at sicker people, with comorbid depression or other diagnoses and on other medications, have been less promising. All of these studies have been pretty small – more work is needed before we can say with confidence whether ketamine can work for OCD, and for whom.
Q: When should ketamine be considered for OCD?
A: Given the mixed state of the research to date, ketamine is not considered a treatment for OCD – it is much better to stick with treatments that are better studied and better proven to work. However, when OCD occurs together with severe depression, ketamine can be an important treatment option for the depression. Sometimes when depression improves, OCD can follow.
Q: What are psychedelics?
A: Psychedelics are a group of drugs that cause dramatic changes in consciousness or perception. Examples include lysergic acid diamide (AKA LSD), psilocybin (the active drug in psychedelic mushrooms), and MDMA, (AKA ‘Ecstasy’). They mostly act on the serotonin system in the brain. There has been increasing interest in the potential use of these drugs as treatments for a range of psychiatric conditions. These drugs are strictly regulated by the U.S. Food and Drug Administration and are not currently legal at the federal level, although their status under state law varies.
Q: Is ketamine a psychedelic?
A: Some people use the term ‘psychedelic’ very broadly and include drugs like ketamine. Others (including the writer of this website!) think that’s not useful, as ketamine and the classical psychedelics like LSD and psilocybin are very different drugs. Ultimately it doesn’t matter so much what we call the drugs – what matters is whether they can help, and what risks or side effects they may entail.
Q: Do psychedelic drugs like LSD and psilocybin help in OCD?
A: This question is being actively researched. While there are some good studies suggesting that psilocybin can be useful for some people with depression, in OCD we know very little as of yet. Some early studies (not all published yet) are promising, but they are very small, and they are limited to people who meet very strict eligibility and safety criteria. More research is needed.
Q: What about MDMA?
A: Methoxy-D-methamphetamine, or MDMA (also called Ecstasy) is a psychedelic-like drug, sometimes called an entactogen or an empathogen. It is being intensively studied for the treatment of PTSD, and some studies suggest benefit, though it is not approved by the Food and Drug Administration and is tightly regulated by the U.S. Drug Enforcement Agency. There is no published work on the use of MDMA in the treatment of OCD.
Q: What are the risks of psychedelic drugs?
A: These drugs remain tightly regulated by the U.S. Food and Drug Administration and are not legally available in the United States outside of research settings (though underground use persists). There is concern that they may destabilize people who are at risk for psychotic symptoms, although the nature of this risk is not well understood. Use outside of controlled settings can often lead to negative experiences (sometimes called ‘bad trips’). It is premature to suggest treatment with psychedelics outside of controlled research settings.