Ketamine has gained attention as a potential treatment for obsessive-compulsive disorder (OCD), particularly for those with severe or treatment-resistant OCD that hasn’t responded well to standard therapies. While some small studies suggest it may temporarily reduce symptoms, ketamine is not FDA-approved for OCD, and experts caution that its benefits are short-lived and experimental.
Understanding how ketamine works, its safety profile, and how it compares to proven treatments so you can make the most informed decisions about care.
What is ketamine therapy?
Ketamine is a dissociative anesthetic that can create feelings of detachment from surroundings and pain. Unlike classic psychedelics like LSD or psilocybin, ketamine is a non-classic psychedelic, as it does not primarily interact with serotonin 2A receptors. Instead, it acts on the neurotransmitters dopamine and glutamate.
Originally used as a battlefield anesthetic and still used in emergency rooms, ketamine has drawn interest for treating mental health conditions like depression, PTSD, and OCD, especially for those who don’t respond to conventional therapies. Ketamine’s effects are typically rapid, often within hours, unlike antidepressants, which can take weeks to months.
Administration methods of ketamine include:
- Intravenous (IV) infusion: Most common in clinics
- Intramuscular (IM) injection: Less common
- Nasal spray: Usually for treatment-resistant depression
Does ketamine work for OCD?
“There is no compelling evidence at this point for the efficacy of ketamine for OCD,” says Jamie Feusner, MD, Chief Medical Officer at NOCD. Its use is off-label, and treatment protocols vary widely among clinicians.
Here are the research findings:
- Only a few small clinical trials exist.
- A 2013 study involving 15 participants showed symptom improvement; however, the study was open-label and not controlled, so the results may be biased.
- Any symptom relief is usually short-lived, often lasting only 1-3 hours.
Some patients report an ego-dissolving effect, which can temporarily reduce the grip of OCD. However, ketamine does not teach coping skills or address daily challenges caused by OCD.
“ We’re looking at it as a way to expand our toolkit for different treatment options, and especially to address the people who have been labeled as treatment-resistant,” says Uma Chatterjee, MS, MHPS, a neuroscientist, science communicator, and mental health advocate.
Is ketamine safe for OCD?
Ketamine is generally considered safe under clinical supervision, but it is not FDA-approved for OCD.
Potential safety concerns include:
- Dependency: Risk of substance use disorder, particularly psychological dependence.
- Overdoses and “k-holes”: Rarely lethal, but high doses can cause unconsciousness, paranoia, delusions, or schizophrenia-like symptoms.
- Medical supervision: Administration should occur in clinics, not at home.
- Limitations: Not recommended for individuals with severe cardiovascular disease, liver disease, or psychosis-related conditions.
- Barriers to care: High cost and limited insurance coverage. Most patients need 6-8 infusions. “I do not think ketamine treatment is accessible to most people due to costs, limited insurance coverage, and the fact that not a lot of clinics offer it,” says Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer.
What is the best treatment for OCD?
The most effective treatment for OCD is exposure and response prevention (ERP) therapy. ERP is a specialized form of cognitive behavioral therapy (CBT) proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms.
Studies show that ERP therapy is highly effective, with 80% of people with OCD experiencing a significant reduction in their symptoms.
“You always want to start with ERP,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. “Just because something is new doesn’t mean it’s better. We know ERP works.”
Other approaches that may help include:
- Medication (typically SSRIs)
- Mindfulness-based strategies
- Acceptance and commitment therapy (ACT)
These are typically done in combination with ERP therapy, depending on the individual’s needs.
Severe or treatment-resistant OCD may benefit from the following therapies:
- Intensive outpatient programs (IOPs)
- Partial hospital programs (PHPs)
- Residential treatment centers (RTCs)
- Transcranial magnetic stimulation (TMS)
- Deep brain stimulation (DBS)
- Gamma knife radiosurgery (GKRS)
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Frequently asked questions
Spravato is FDA-approved for treatment-resistant depression, not OCD. Some clinicians may prescribe it off-label; however, research is limited, and the results are mixed. Only use under guidance from a prescriber with specialized training in OCD.
Bottom line
Ketamine therapy is experimental for OCD. Some individuals may experience temporary symptom relief, but it is not a cure for the condition. Evidence-based treatments like ERP therapy and medication are the standard therapies for managing OCD.
Key takeaways
- Ketamine is an experimental, off-label treatment for OCD that acts on the brain’s glutamate system.
- Research on ketamine for OCD is limited, with small studies showing only short-term symptom relief.
- Ketamine carries safety risks, including dependency, dissociation, and high costs with limited insurance coverage.
- Experts recommend evidence-based treatments like ERP therapy and medication to manage OCD symptoms.
