Intranasal Ketamine and Cognitive-Behavioral Therapy for Treatment Refractory Obsessive-Compulsive Disorder

Abstract

To the Editors: R efractory obsessive-compulsive disorder (OCD) is a common and vexing clinical problem. Agents that modulate glutamate, including theN-methyl-Daspartate antagonist ketamine, have been the focus of recent interest for the treatment of this population, but experience to date has been mixed. Ketamine is a rapid-acting antidepressant that enhances cellular mechanisms associated with neural plasticity in prefrontal circuitry associated with extinction learning. This raises the intriguing possibility that ketamine may potentiate extinctionbased psychotherapy for OCD.