Ketamine for OCD: Effectiveness and Treatment Options in Canada

Did you know that obsessive-compulsive disorder (OCD) affects approximately 1 in 100 adults in Canada? I’ve dedicated my career to mental health services and I’ve seen the toll severe OCD and other mental health disorders can take. The endless rituals, intrusive OCD thoughts, the paralyzing anxiety, the impact on relationships and careers. 

Ketamine for OCD, as strange as that may sound, has proven to be effective and reliable in treating the most difficult of mental health problems.  

Now, you might be wondering, “Isn’t ketamine just an anesthetic?” Well, yes and no. While it’s true that ketamine has been used as an anesthetic for decades, its potential in mental health treatment is profound.  

So how exactly do doctors use ketamine for OCD treatment, and how does it differ from traditional OCD treatment options?

What is Obsessive Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is a common mental health condition I’ve treated many times over my career. OCD is an anxiety disorder characterised by two main components: obsessions and compulsions.

Imagine your brain getting stuck on a particular thought or urge. That’s an obsession. These thoughts are often intrusive and unwanted, causing significant distress and depressive symptoms.

Compulsions, on the other hand, are the repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. It’s as if the mind is trying to bargain with anxiety, saying, “If I just do this one thing, everything will be okay.”

OCD is more prevalent than you might think. In my years of practice, I’ve seen severe OCD affect people from all walks of life. Statistics show that about 2-3% of the population experiences OCD at some point in their lives. That’s millions of people worldwide struggling with this challenging disorder every day.

The impact of OCD on daily life is extreme. OCD doesn’t just steal time; it can strain relationships, interfere with work or school, and significantly diminish quality of life. Simple tasks become arduous challenges. Imagine spending hours checking if you’ve locked the door, or washing your hands until they’re raw because of contamination fears. These obsessive-compulsive symptoms can severely impair cognitive control and overall functioning.

Obsessive Compulsive Disorder (OCD) symptoms and subtypes

When it comes to OCD symptoms, they’re as diverse as the people who experience them. Some common themes I’ve observed in my practice include:

1. Contamination OCD: An intense fear of germs or dirt.
2. Checking OCD: Repeatedly checking things like locks, appliances, or switches.
3. Symmetry OCD: A need for things to be perfectly aligned or balanced.
4. Harm OCD: Intrusive thoughts about harming oneself or others.
5. Religious or moral OCD: Obsessive concerns about blasphemy or morality.

Each subtype of OCD presents its own unique challenges. These aren’t quirks or preferences – they’re symptoms of a disorder that can be incredibly distressing.

It’s crucial to understand that OCD is not about being overly tidy or particular. It’s a real, diagnosable condition that can significantly impact a person’s life. 

In my experience, the first step towards healing is understanding. By recognizing OCD for what it is – a mental health condition, not a personal failing – we open the door to effective treatment and support.

Traditional Treatment Strategies for Treating OCD

In my years of practice, I’ve seen the treatment landscape for OCD evolve significantly. While healthcare made great strides, there’s still room for improvement. Let’s take a look at available OCD treatments and why ketamine-assisted therapy stands out.  

What are traditional treatments for OCD?

In the broader healthcare landscape, we typically see two approaches to OCD treatment. Let me break it down for you:

First, there’s the medication route. Most healthcare providers start with prescribing selective serotonin reuptake inhibitors (SSRIs). These traditional antidepressants have shown good efficacy in managing OCD symptoms. The idea is to help regulate the brain’s serotonin levels, which can reduce the intensity of obsessive thoughts and compulsive behaviors. 

The other approach is therapy. Many healthcare providers use Cognitive Behavioral Therapy (CBT). For OCD, they specifically employ a type of CBT called Exposure and Response Prevention (ERP). ERP is a bit like a workout for the brain – it’s challenging but effective. 

During Exposure and Response Prevention (ERP), the therapist works with the patient to gradually confront their OCD triggers in a controlled environment. At the same time, they learn to resist the urge to perform their usual repetitive behaviors. It’s a process of retraining the brain, teaching it new ways to respond to these triggers.

Limitations and challenges of traditional treatments for OCD

Now, you might be thinking, “That sounds great! Problem solved, right?” Well, not quite. While these treatments work for some, the hard truth is that up to 40% of OCD patients don’t respond adequately to these conventional treatments. That’s millions of people left searching for solutions.

With traditional pharmacological treatment, it’s a game of trial and error. Finding the right drug and dosage can take time, and some OCD patients experience side effects that are hard to manage. 

Some patients on SSRIs may experience other unwanted effects like weight gain or decreased libido from SSRIs.

As for ERP therapy, it’s incredibly effective… when OCD patients can stick with it. ERP can be intensely anxiety-provoking. Imagine asking someone with contamination OCD to touch a doorknob and not wash their hands. Some patients find it too overwhelming and drop out of treatment.

Treatment-resistant obsessive compulsive disorder is another challenge altogether. I’ve worked with patients who’ve tried multiple medications and gone through extensive therapy, but still struggle with debilitating symptoms. It’s heartbreaking to see, and it’s what drives me to expand the availability of ketamine-assisted psychotherapy. 

Why Ketamine for OCD

Ketamine isn’t new. It’s been around since the 1960s, primarily used as an anesthetic. In the early 2000s, researchers noticed something unexpected. Patients receiving ketamine for pain management reported rapid improvements in mood. This sparked a wave of interest in the research community. Could this anesthetic hold the key to treating stubborn mental health conditions like major depressive disorder or treatment resistant depression?

Research on Ketamine for OCD Treatment

Now, I know you’re curious about the evidence. As a physician, I’m always examining the latest research, and when it comes to ketamine for OCD, the findings are promising.

Ketamine treatment, particularly through ketamine infusions, has shown promising results in clinical trials for severe obsessive-compulsive disorder and other challenging disorders. Repeated ketamine infusions have demonstrated therapeutic effects in patients who haven’t responded to traditional psychiatric treatments. The Dr. Carolyn Rodriguez lab at Stanford University has been a pioneer in the research on ketamine and OCD. I saw Dr Rodriquez speak at the International OCD Symposium in Chicago in 2016 in her ketamine and OCD work.  

The American Psychiatric Association and World Health Organization are closely monitoring these developments. Current research is also investigating the glutamate hypothesis of OCD and the role of gamma-aminobutyric acid (GABA) in the disorder, which may further explain ketamine’s antidepressant effects and its efficacy in treating OCD.

This table includes a systematic review, a randomized controlled crossover trial, and case reports that demonstrate the potential of ketamine for OCD treatment. Their findings about ketamine indicate fast onset of action, good tolerability, and significant improvement in OCD symptoms.

Study Title	Date	Key Findings
Ketamine in the Treatment of Obsessive-Compulsive Disorder	2022	Potential for fast onset of action and good tolerability of ketamine for OCD
Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder	2013	Modest but statistically significant improvement in OCD symptoms; rapid anti-obsessional effects
Ketamine Augmentation of Exposure Response Prevention Therapy for OCD	2024	Ketamine may augment traditional ERP therapy, testing its efficacy in treatment-resistant patients
Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive disorder	2020	Ketamine shows promise in treating OCD resistant to traditional SRI approaches

How Ketamine Affects the Brain with OCD and Related Disorders

Ketamine is an effective treatment for various mental health disorders, including obsessive-compulsive disorder (OCD), major depressive disorder, and treatment-resistant depression. To understand why ketamine is so effective for OCD treatment, we need to explore its impact on brain chemistry and function.

Ketamine’s Unique Mechanism of Action

Unlike traditional antidepressants such as selective serotonin reuptake inhibitors (SSRIs), ketamine targets glutamate, the brain’s most common chemical messenger. This unique approach makes it particularly effective in treating various psychiatric disorders, including mood disorders and anxiety disorders.

Brain Circuit Modulation

Imagine your brain regions as a complex subway system. In a healthy brain, thoughts and emotions travel smoothly along neural ‘subway lines’. However, in OCD and related neuropsychiatric disorders, certain lines become overcrowded and chaotic, with thoughts getting stuck in repetitive loops.

Ketamine acts like a master subway controller, rapidly rerouting these jammed lines and creating new express routes and alternate pathways. This helps break the gridlock of obsessive-compulsive symptoms and compulsive behaviours.

BDNF Production, Neuroplasticity and Brain Remodeling

Ketamine doesn’t just reroute existing pathways – it promotes neuroplasticity, the brain’s ability to form new connections and reorganize itself. This is akin to giving your brain’s subway system a major upgrade, complete with new lines and improved stations.

Ketamine increases the production of proteins like Brain-Derived Neurotrophic Factor (BDNF), which acts as a construction crew for your brain, helping build and maintain new neural connections.

Ketamine’s Molecular Mechanism

At the molecular level, ketamine works by binding to N-methyl-D-aspartate (NMDA) receptors in the brain, which are like docking stations for glutamate. This binding temporarily blocks the receptor, setting off a cascade of events that lead to rapid antidepressant effects and anti-OCD effects. The Rodriguez Lab has shown that the GABA/Glutamate pathway may be implicated in OCD pathology in the brain, and ketamine may normalise this for some patients. 

The benefits of ketamine for OCD treatment

From my experience as a healthcare provider guiding patients through ketamine-assisted therapy for obsessive-compulsive disorder (OCD), the most important benefit is ketamine’s rapid action. Many patients report a significant reduction in obsessive thoughts and compulsive behaviours shortly after treatment.

While traditional medications for OCD like SSRIs can take weeks or even months to kick in, ketamine can provide relief within hours or days. For someone trapped in the exhausting cycle of OCD, this quick relief can be nothing short of life-changing.

At Field Trip Health clinics specializing in ketamine treatment, here are the other benefits of ketamine we see in our patients after ketamine-assisted therapy:

1. Increased effectiveness of therapy: Ketamine seems to make the brain more receptive to therapeutic interventions like exposure and response prevention therapy. It’s like it opens a window of opportunity for change. It enhances extinction learning, a cornerstone of how psychotherapy for anxiety disorders is thought to work. 
2. Long-term impact: While the immediate effects of ketamine wear off, the changes it promotes in the brain can lead to lasting improvements in OCD symptoms. This is not exclusively negative affectivity; patients often report positive changes in their overall mental health condition.
3. Hope for treatment-resistant cases: For those who haven’t found relief with standard treatments to treat OCD, ketamine offers a new avenue of hope. Some patients who haven’t responded to other treatments, including deep brain stimulation or transcranial magnetic stimulation, have found relief with ketamine.
4. Improved quality of life: As OCD symptoms decrease, many patients report feeling more present, less anxious, and better able to engage in daily activities without cognitive impairment.

It’s important to note that ketamine isn’t a one-and-done treatment. Patients see the greatest benefits from a series of ketamine infusions or intramuscular injections , followed by maintenance treatments as needed. 

Safety and Efficacy of Ketamine for OCD

As a physician who’s been working with ketamine therapy, I often get asked about its safety and effectiveness. It’s a valid concern – after all, we’re talking about a powerful medication used in a new way.

Potential Risks and Side Effects of Ketamine Use

First things first: like any medical treatment, ketamine therapy isn’t without its risks and side effects. But don’t worry – most are mild and short-lived. Here’s what you might experience:

1. Dissociation: This is the most common effect. You might feel disconnected from your body or surroundings. It’s temporary and actually part of how ketamine works its magic.
2. Nausea: Some patients feel a bit queasy. We can usually manage this with anti-nausea medication if needed.
3. Increased blood pressure: We monitor this closely during treatment.
4. Dizziness or drowsiness: You might feel a bit off-balance for a few hours after treatment.
5. Vivid dreams or hallucinations: These can occur but are typically not distressing.

Some long-term risks include potential bladder issues with prolonged, frequent use, and the possibility of developing tolerance or dependence. It’s important to note that at Field Trip Health clinics we use a much lower sub anesthetic dose that is not associated with these risks.

Managing Side Effects in Ketamine Treatment

Now, don’t let that list of side effects scare you off. At Field Trip Health, we’ve got several strategies to manage these side effects:

1. Proper dosing: We start with low doses and slowly increase if necessary, tailoring the dose to each individual.
2. Controlled environment: Treatments happen in a calm, safe space with medical supervision.
3. Pre-treatment preparation: We’ll give you tips on how to prepare, like fasting for a few hours before treatment to reduce nausea.
4. Monitoring: We keep a close eye on your vital signs throughout the treatment.
5. Post-treatment care: We make sure you’re feeling stable before sending you home, and we’re always available if you have concerns after treatment.

Most patients find the side effects manageable and well worth the potential benefits. It’s like going to the gym – you might be a bit sore afterwards, but the long-term gains make it worthwhile.

Is Ketamine Therapy for OCD Safe?

Now for the million-dollar question: is ketamine therapy for OCD safe? Based on current research and my clinical experience, I can say that when administered properly in a controlled medical setting, ketamine therapy is safe for most people.

Here’s why I feel confident about ketamine’s safety profile:

1. Medical supervision: Ketamine therapy for OCD is always administered under the watchful eye of trained medical professionals.
2. Controlled dosing: We use much lower doses than those used for anesthesia or recreational use. 
3. Screening process: Before starting treatment, we do a thorough evaluation to ensure ketamine is appropriate for you.
4. Short-term use: Ketamine therapy for OCD typically involves a series of treatments, not long-term daily use.
5. Established safety record: Ketamine has been used safely in medical settings for decades.

Who May Benefit from Ketamine for OCD Treatment

I’ve had many patients struggle with OCD and I’ve seen ketamine-assisted therapy help many struggling with OCD. But like any treatment, it’s not a one-size-fits-all solution. Let’s talk about who might benefit most from ketamine therapy for OCD, who might want to explore other options, and how to find the right provider.

Identifying Ideal Candidates for Ketamine Therapy

When I’m considering ketamine therapy for a patient with OCD, I look at several factors:

1. Treatment-resistant OCD: If you’ve tried standard treatments like SSRIs and cognitive-behavioral therapy without much success, ketamine might be a good next step. 
2. Severe symptoms: For those whose OCD symptoms significantly impact daily life, the rapid relief ketamine can provide might be particularly beneficial. Imagine being able to turn down the volume on those intrusive thoughts within hours instead of weeks or months.
3. Openness to new treatments: Ketamine therapy is a bit different from popping a daily pill. Ideal candidates are those who are willing to try an innovative approach and are comfortable with the idea of IV infusion or intramuscular injection treatments.
4. Ability to commit to the treatment schedule: Ketamine therapy typically involves a series of infusions or injections  over several weeks, followed by maintenance treatments. If you can commit to this schedule, you’re more likely to see the full benefits.
5. Co-occurring depression or anxiety: Many people with OCD also struggle with treatment resistant depression or anxiety. Ketamine has shown promise in treating these conditions too with double the benefit.

Who May Not Qualify for Ketamine for OCD Treatment?

Ketamine therapy for OCD may not be right for some patients. Here are some risk factors where we might need to be more cautious:

1. History of psychosis: Ketamine can potentially exacerbate psychotic symptoms, so it’s generally not recommended for people with schizophrenia or other psychotic disorders.
2. Uncontrolled high blood pressure: Ketamine can cause a temporary increase in blood pressure, so it might not be safe if your blood pressure isn’t well-controlled.
3. Pregnancy or breastfeeding: We don’t have enough data on ketamine’s effects during pregnancy or breastfeeding, so we typically avoid it in these situations.
4. Active substance abuse: If you’re currently struggling with substance abuse, ketamine therapy might not be appropriate. We’d want to address the substance use first.
5. Certain medical conditions: Some medical conditions, like severe liver disease or certain heart conditions, might make ketamine therapy too risky.
6. Inability to arrange transportation: Because ketamine can cause drowsiness, you’ll need someone to drive you home after each treatment. If you can’t arrange this, it might not be feasible.
7. Severe dissociative disorders: Since ketamine can cause feelings of dissociation, it might not be suitable if you have a severe dissociative disorder.

Ketamine-Assisted Therapy for OCD

As someone who’s worked closely with ketamine therapy, I’m often asked what the process looks like. At Field Trip Health, we’ve developed a comprehensive approach to ketamine-assisted therapy for OCD. Let me walk you through what you can expect at each stage of the treatment.

Consultation

Your treatment begins with a thorough consultation. Here’s what you can expect:

• Step 1: A comprehensive assessment of your OCD symptoms and overall mental health
• Step 2: Review of your medical history and previous treatments
• Step 3: Discussion about ketamine therapy and how it might benefit your specific case
• Step 4: Opportunity to ask questions and address any concerns you might have
• Step 5: Determination of whether ketamine therapy is appropriate for you

Remember, this isn’t just a formality. It’s a chance for us to get to know you and for you to get comfortable with our team. We want to make sure we’re on the same page before moving forward.

Preparation

Once we’ve decided to proceed with ketamine therapy, we’ll help you prepare for your first session:

• You’ll receive detailed instructions on how to prepare physically and mentally
• We’ll discuss what to wear, what to bring, and what to avoid before your session
• You’ll learn about potential effects of ketamine and how to navigate them
• We’ll help you set intentions for your therapy
• You’ll meet your therapy team and familiarize yourself with the treatment space

Think of this as laying the groundwork for a transformative experience. The more prepared you are, the more you’re likely to benefit from the therapy.

Experience

Here’s what a typical ketamine therapy session at Field Trip Health looks like:

• You’ll be welcomed into a comfortable, private room designed for ketamine therapy
• Your vital signs will be checked, and you’ll get settled in a cozy recliner
• The ketamine will be administered, usually via intramuscular injection
• You’ll wear an eye mask and listen to calming music to enhance the experience
• A trained therapist will be with you throughout the session to ensure your comfort and safety
• The active part of the session typically lasts about 45-60 minutes, but you’ll have time to relax and recover afterwards

During the experience, you might feel a sense of dissociation or detachment from your usual thought patterns. This is where the therapeutic potential lies – it’s an opportunity for your mind to break free from ingrained OCD patterns.

Integration

The treatment doesn’t end when the ketamine wears off. In fact, some might say this is where the real work begins:

• You’ll have a integration session with your therapist to process your experience
• We’ll help you unpack any insights or emotions that came up during the ketamine session
• You’ll learn techniques to apply these insights to your daily life and OCD management
• We’ll work with you to develop new coping strategies based on your experience
• You’ll receive guidance on how to maintain and build upon the progress you’ve made

Integration is crucial. It’s how we turn the ketamine experience into lasting change for your OCD symptoms.

Reconnect and Reassess

Ketamine therapy isn’t a one-and-done treatment. At Field Trip Health, we believe in ongoing care:

• We’ll schedule follow-up appointments to monitor your progress
• You’ll have the opportunity to discuss any changes in your OCD symptoms
• We’ll adjust your treatment plan as needed based on your response
• You may have additional ketamine sessions, spaced out according to your individual needs
• We’ll provide ongoing support to help you maintain your progress

Throughout this process, we’re not just treating your OCD – we’re partnering with you on your mental health journey. Our goal at Field Trip Health is to provide you with the tools and experiences you need to find lasting relief from OCD symptoms.

FAQ

About the Author

Dr. Mario Nucci MD CCFP is a licensed Family Physician with a passion for mental health and the development of new therapies. He is actively engaged in research with a faculty associate professorship at Northern Ontario School of Medicine, and research collaborations with the University of Ottawa, University of Calgary, Lakehead University, Concordia University and Vancouver Island University.

Dr. Nucci is the founder of Bay and Algoma Health Centre in 2019, a walk-in and addiction medicine clinic. He founded the Canadian Centre for Psychedelic Healing in 2019, now operating as Field Trip Health, providing cutting edge mental health care in Toronto, Montreal, Vancouver, Ottawa,  Hamilton, Kitchener-Waterloo, Thunder Bay, Sault Ste. Marie, and at-home.