Ketamine Infusion for Obsessive-Compulsive Disorder
Condition: Obsessive-compulsive Disorder
MeSH terms: Compulsive Personality Disorder; Obsessive-Compulsive Disorder
Intervention: ketamine
Intervention description: Ketamine (a single 0.5mg intravenously over 40 minutes).
Intervention MeSH terms: Ketamine
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 10.0
Sex: All
Minimum age: 18 Years
Maximum age: 65 Years
Healthy volunteers: No
Keywords: obsessive-compulsive disorder; ketamine; glutamate

Summary:

      Roughly one-third of patients with obsessive-compulsive disorder (OCD) do not experience
      significant clinical benefit from first-line interventions such as pharmacotherapy with
      selective serotonin reuptake inhibitors (SSRI) or cognitive behavioral therapy (CBT).
      Furthermore, OCD patients typically experience the full treatment benefits of first-line
      interventions only after a time-lag of two to three months. Inadequate symptom relief and
      delay of symptom relief from first-line treatments are sources of substantial morbidity and
      decreased quality of life in OCD patients. Converging lines of evidence from neuroimaging,
      genetic and pharmacological studies support the importance of glutamate abnormalities in the
      pathogenesis of OCD.

      The investigators are conducting an open, uncontrolled study of ketamine in
      treatment-refractory OCD. Ketamine is a potent antagonist of the N-methyl-D-aspartate (NMDA)
      receptor and has been demonstrated to have rapid anti-depressant effects in patients with
      Major Depressive Disorder. The investigators have additionally provided evidence for rapid
      improvement of comorbid OCD and trichotillomania after ketamine infusion in a depressed
      woman.

      Failure of symptom relief and delay of symptom relief from first-line treatments are a source
      of substantial morbidity and decreased quality of life in OCD patients. Ketamine represents
      the possibility to provide rapid symptom relief to OCD patients and may provide the mechanism
      for future drug development to treat OCD more rapidly and effectively.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Adult between the ages of 18 and 65 years.

          2. Meet DSM IV criteria for obsessive-compulsive disorder by structured clinical
             interview (SCID) and have a Y-BOCS score >24.

          3. Have treatment-refractory OCD. Have Y-BOCS>24 despite two SSRI trials of adequate dose
             and duration and been offered prior CBT treatment.

          4. Stable psychiatric medications. Subjects must have had stable doses of all psychiatric
             medications for the month prior to treatment and have been on stable doses of SSRI and
             clomipramine for at least 2 months prior to study enrollment.

          5. Medically and neurologically healthy.

          6. Able to provide written informed consent according to the Yale HIC guidelines.

        Exclusion Criteria:

          1. Lifetime history of substance dependence (other than nicotine and caffeine)

          2. Suicide attempt or suicidal ideation requiring psychiatric hospitalization in the
             previous 6 months

          3. Being Pregnant

          4. Known hypersensitivity to ketamine