Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive disorder

Sharma, Lavanya P; Thamby, Abel; Balachander, Srinivas; Janardhanan, C Narayanaswamy; Jaisoorya, T S; Arumugham, Shyam Sundar; Reddy, Y.C. Janardhan

doi:10.1016/j.ajp.2020.102183

Cited by 19 publications

(24 citation statements)

References 17 publications

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“…The findings are described in detail and organized in relation to the specific type of article and order of publication (see Table 1). Studies retrieved were represented by nine case series/case reports [13,[40][41][42][43][44][45][46][47][48], six randomized-controlled trials [49][50][51][52][53][54], ten open-label studies [55][56][57][58][59][60][61][62][63][64][65] and three double blind trials [66][67][68]. Most cases involved adult males (total M/F = 328/160= 2.1).…”

Section: Resultsmentioning

confidence: 99%

“…Most cases involved adult males (total M/F = 328/160= 2.1). Patients were mostly diagnosed with OCD [13,40,45,47,55,56,[60][61][62][63][64] or a SUD, such as opioid dependence [41,[43][44][45][46][57][58][59], cocaine dependence [49,50,52,[66][67][68] or alcohol dependence [51,54,65]. Only three studies focused on ED [42,46,48].…”

Section: Resultsmentioning

confidence: 99%

“…Only three studies focused on ED [42,46,48]. Ketamine was mostly intravenously administered [42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][59][60][61][65][66][67], but intranasal [40,62], intramuscular [46,58,68] and oral [13,41] routes of administration were also recorded. Ketamine was administered together with Cognitive Behavioral Therapy (CBT) [40,43], or in the context of ketamine-assisted psychotherapy (KPT) sessions [58,68] or Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories (TIMBER) [59].…”

Section: Resultsmentioning

confidence: 99%

“…According to the literature [3,40,55], ketamine via IV infusion significantly improves obsessive-compulsive symptomatology, with effects that are rapid (occurring in hours to minutes) but short-lasting (days to weeks) [13,40,45,47,55,56,[60][61][62][63]. Interestingly, CBT prolongs ketamine effects [30,40,43,56,69].…”

Section: Ocdmentioning

confidence: 99%

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Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

et al. 2021

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The obsessive–compulsive spectrum refers to disorders drawn from several diagnostic categories that share core features related to obsessive–compulsive disorder (OCD), such as obsessive thoughts, compulsive behaviors and anxiety. Disorders that include these features can be grouped according to the focus of the symptoms, e.g., bodily preoccupation (i.e., eating disorders, ED) or impulse control (i.e., substance use disorders, SUD), and they exhibit intriguing similarities in phenomenology, etiology, pathophysiology, patient characteristics and clinical outcomes. The non-competitive N-methyl-D-aspartate receptor (NMDAr) antagonist ketamine has been indicated to produce remarkable results in patients with treatment-resistant depression, post-traumatic stress disorder and OCD in dozens of small studies accrued over the past decade, and it appears to be promising in the treatment of SUD and ED. However, despite many small studies, solid evidence for the benefits of its use in the treatment of OCD spectrum and addiction is still lacking. Thus, the aim of this perspective article is to examine the potential for ketamine and esketamine in treating OCD, ED and SUD, which all involve recurring and intrusive thoughts and generate associated compulsive behavior. A comprehensive and updated overview of the literature regarding the pharmacological mechanisms of action of both ketamine and esketamine, as well as their therapeutic advantages over current treatments, are provided in this paper. An electronic search was performed, including all papers published up to April 2021, using the following keywords (“ketamine” or “esketamine”) AND (“obsessive” OR “compulsive” OR “OCD” OR “SUD” OR “substance use disorder” OR “addiction” OR “craving” OR “eating” OR “anorexia”) NOT review NOT animal NOT “in vitro”, on the PubMed, Cochrane Library and Web of Science online databases. The review was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The use and efficacy of ketamine in SUD, ED and OCD is supported by glutamatergic neurotransmission dysregulation, which plays an important role in these conditions. Ketamine’s use is increasing, and preliminary data are optimistic. Further studies are needed in order to better clarify the many unknowns related to the use of both ketamine and esketamine in SUD, ED and OCD, and to understand their long-term effectiveness.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Ocdmentioning

confidence: 99%

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Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

et al. 2021

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“…The mechanism of antidepressant action of esketamine has not been fully clarified yet but modulation of different signaling pathways implicated in the pathophysiology of MDD, such as synaptogenesis and neuroplasticity pathways, may play a role [ 21 , 22 ]. Although off-label, encouraging results have emerged from the use of intravenous ketamine in treatment resistant OCD as reported by previous clinical studies and case reports [ 23 – 26 ], hence the growing interest in the use of intranasal esketamine in treatment resistant OCD.…”

Section: Introductionmentioning

confidence: 99%

The use of esketamine in comorbid treatment resistant depression and obsessive compulsive disorder following extensive pharmacogenomic testing: a case report

et al. 2021

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Background Major depressive disorder (MDD) patients not responding to two or more different antidepressant treatments are currently considered to suffer from treatment resistant depression (TRD). Recently, intranasal esketamine has been approved by both the American Food and Drug Administration and European Medicines Agency for TRD and, more recently, in moderate to severe episode of MDD, as acute short-term treatment for the rapid reduction of depressive symptoms, which, according to clinical judgement, constitute a psychiatric emergency. There is currently no indication for obsessive–compulsive disorder (OCD) although recently published studies have already shown a rapid and significant reduction of OCD-like symptoms following ketamine administration. The etiology of OCD has not yet been fully elucidated but there is a growing evidence that glutamate signaling dysfunction in the cortico-striatal–thalamo-cortical circuitry plays an essential role. This case report exemplifies possible clinical effects of esketamine on both depressive and OCD symptoms. Case presentation We present the case of a 39-year-old man suffering from TRD. During the first evaluation at our clinic, he also reported the presence of OCD spectrum symptoms, causing him to perform time-consuming mental rituals due to pathological doubts regarding the relationship with his wife as well as intrusive thoughts regarding his mental conditions. He underwent psychometric evaluations, therapeutic drug monitoring analysis, and pharmacogenomic tests. The overall results helped to explain patient’s treatment-resistance. Moreover, we observed a significant reduction in both depressive and OCD symptoms after administration of esketamine. Conclusion This case underlines the importance of pharmacogenomic tests in profiling TRD patients and confirms the possible use of esketamine in the treatment of comorbid OCD.

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Pharmacotherapeutic Strategies and New Targets in OCD

Pittenger

2021

Current Topics in Behavioral Neurosciences

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Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive disorder

Cited by 19 publications

References 17 publications

Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

The use of esketamine in comorbid treatment resistant depression and obsessive compulsive disorder following extensive pharmacogenomic testing: a case report

Pharmacotherapeutic Strategies and New Targets in OCD

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