If you have OCD and have sought treatment for it, you probably know that the frontline treatments are E/RP (Exposure/ Response Prevention) therapy and antidepressants. The antidepressants typically used for treatment of OCD are called Selective Serotonin Reuptake Inhibitors, or SSRIs. Some SSRIs commonly used for treatment of OCD are Prozac and Zoloft. These medications work by increasing the availability of the neurotransmitter serotonin– which is associated with mood, learning, and memory– in the brain. SSRIs at higher doses can be effective in treating OCD. However, more and more research is emerging suggesting that OCD symptomology is related to the an excitatory neurotransmitter called Glutamate.
Glutamate is also a key neurotransmitter involved in the psychoactive mechanism of Ketamine. There’s some evidence that high absorption of Glutamate in the brain can contribute to chronic depression, and ketamine can be affective in blocking glutamine receptors. This may be why ketamine has been so effective in treating depression, and why some studies have shown that it is highly effective in reducing the symptoms of OCD. Old overactive receptors are blocked, and new neuronal pathways are rapidly formed. This process is called neuroplasticity. It is the essential element in the therapeutic effects of ketamine.
Everyone’s personal experience with ketamine is different. Some of my clients report complete dissociation—feeling completely disconnected from their bodies, unsure of the boundaries between self and others, unsure of the limits of reality. This dissociative reaction, which typically comes from a higher “psychedelic” dose of ketamine, may be accompanied by visual effects. Some of my clients report seeing elements of the same visuals repeatedly, every time they journey. This type of journey is more likely to incorporate transpersonal experience. Transpersonal experience, sometimes called ego death in common parlance, is the feeling of a dissolution of self and a connection to a greater whole. It’s a state of mind that necessitates full surrender to the medicine, to the experience as it comes. The ketamine itself can help initiate the surrender, but willing participation on the part of the individual is also integral.
Logically, it’s clear why such an experience may help with the treatment of OCD. OCD is desperate for control at all times and has a firm grasp on the psyche of its sufferers. Even if the concept of surrender or letting go sounds relieving to many OCD sufferers, there is little precedent in the brain for the individual to work with. Working with an ERP therapist helps create that precedent—the ability to “embrace uncertainty” is the core skill taught in OCD treatment—but what if it isn’t enough?
Dr. Jonathan Grayson, a leader in OCD treatment and internationally recognized author, states that OCD is both a learned and a biological disorder. The biological predisposition exists, and an individual learns their rituals (and reinforces their symptoms) in an effort to neutralize anxiety. ERP can be very effective in helping with the learned aspect of OCD. Dr. Grayson adds, though, that in severe cases, medication is also needed to treat the biological aspect of the disorder.
Could this be where ketamine treatment emerges as a standard for OCD treatment in the future? Rather than SSRIs, which a client takes everyday and which can take weeks or months to take effect, will OCD sufferers treat their severe symptoms with Ketamine Assisted Psychotherapy? With the help of their KAP therapist, OCD sufferers can practice the same acceptance of uncertainty standard in all ERP while the medicine’s neuroplastic effects are underway.
The client and the KAP therapist work together in determining the correct dose for the client, depending on their symptoms and their goals. Most KAP clients who present for treatment of OCD opt for a lower dose at first, to ease into the process of letting go that KAP (and OCD) requires. Too high a dose at first can be jarring, and may invite an individual’s typical attempts to control the uncontrollable. This can lead to an unpleasant (but perhaps informative) ketamine experience.
On a lower dose, called a “psycholitic” dose, a patient is typically verbal, aware of the boundaries of self, and focused on deep processing of biographical material. It can look like a typical therapy session, but one in which the patient is free of their usual defenses. Many patients report feeling very relaxed in this state. My clients have reported being able to make deep connections about themselves, their patterns of functioning, and their relationships while processing on a psycholitic dose of ketamine. I believe there is real potential for gaining insight into the etiology and function of OCD, as well as an opportunity to see the broader patterns an individual’s symptoms form over time.
In the days following KAP sessions, client’s should practice their ERP skills and pay close attention to their mood and symptomology. In this window, the “psychedelic glow”, lasting changes can form. As the treatment continues, a patient and their KAP therapist will adjust the dosage of ketamine based on the patient’s reaction so far, their symptoms, and their hopes for treatment.
Research about the efficacy of KAP in OCD treatment is still new, but there is promising evidence that ketamine, especially intravenous injections, can have a strong, immediate effect on OCD symptoms, which can last clients several weeks. As we learn more about the connection between the glutamate pathway, ketamine, and OCD, we will undoubtedly hear more stories of successful treatment.