[Combination of ketamine and esketamine with Exposure and Response Prevention (ERP) therapy for Obsessive-Compulsive Disorder].
Hugo Bottemanne, Alice Arnould, Amaury Najar, Fanny Delaigue, Laure Serresse, Lucie Joly, Stéphane Mouchabac
L'Encephale June 2023 DOI: 10.1016/j.encep.2022.08.011 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Interventions | Ketamine Exposure and response prevention psychotherapy |
| Topics | Ketamine Esketamine |
| Keywords | Epr Erp Fear extinction Kétamine Nmda receptor OCD Obsessional-compulsive disorder Récepteur nmda Toc Trouble obsessionnel compulsif |
| Key findings | The authors suggest that ketamine, an NMDA receptor antagonist, may enhance ERP psychotherapy for OCD by promoting fear extinction and brain plasticity, and they propose a ketamine-augmented ERP (KAP-ERP) protocol while noting limitations to its clinical application. |
Abstract
Obsessive-Compulsive Disorder (OCD), characterized by the combination of obsession and compulsion, is a clinical and therapeutic challenge. Many patients with OCD do not respond to first-line treatments such as serotonin selective reuptake inhibitors (SSRIs) and exposure and response prevention psychotherapy (ERP). For these resistant patients, some preliminary studies have shown that ketamine, a non-selective glutamatergic NMDA receptors antagonist, could improve the obsessive symptoms. A number of these studies have also suggested that the combination of ketamine with ERP psychotherapy may jointly potentiate the effectiveness of ketamine and ERP. In this paper, we present the existing data on the combined use of ketamine with ERP psychotherapy for OCD. We suggest that modulation of NMDA receptor activity and glutamatergic signaling by ketamine may promote the therapeutic mechanisms involved in ERP such as fear extinction and brain plasticity mechanisms. Finally, we propose a ketamine-augmented ERP psychotherapy (KAP-ERP) protocol in OCD, and we present the limitations associated with its application in clinical practice.
Comparable studies
Other narrative reviews on esketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Long-term safety of ketamine and esketamine in treatment of depression | 2022 | Review | |
| Ketamine, Esketamine, and Arketamine: Their Mechanisms of Action and Applications in the Treatment of Depression and Alleviation of Depressive Symptoms. | 2024 | Review | |
| The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. | 2023 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review |
Citations in the library
Cites 12
- Double-Blind, Placebo-Controlled, Dose-Ranging Trial of Intravenous Ketamine as Adjunctive Therapy in Treatment-Resistant Depression (TRD) Molecular Psychiatry October 3, 2018
- Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy Journal of Psychoactive Drugs March 15, 2019
- Features of Dissociation Differentially Predict Antidepressant Response to Ketamine in Treatment-Resistant Depression Journal of Affective Disorders February 17, 2018
- Subanaesthetic ketamine and altered states of consciousness in humans British Journal of Anaesthesia April 13, 2018
- Ketamine Effects on Memory Reconsolidation Favor a Learning Model of Delusions PLoS One June 12, 2013
and 7 more in the library