O uso da cetamina como estratégia terapêutica no Transtorno Obsessivo-Compulsivo
Letícia Macedo Pinto, Lucas Macedo Pinto, Joel Porfírio Pinto
Diálogos Interdisciplinares em Psiquiatria e Saúde Mental October 19, 2026 DOI: 10.59487/2965-1956-5-17094 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Peer reviewed |
|---|---|
| Population | Adults with obsessive-compulsive disorder |
| Interventions | Ketamine Esketamine |
| Dose | 0.5 mg/kg intravenously |
| Key findings | Evidence suggests ketamine, predominantly at 0.5 mg/kg intravenously, produces a rapid and clinically relevant reduction in obsessive-compulsive symptoms within hours, but the effect is transient, with symptoms returning to baseline around one week. The authors argue the acute response is compatible with rapid NMDA-receptor-mediated neuroplasticity and that the short duration limits ketamine as a standalone monotherapy, though it may have synergistic potential with Exposure and Response Prevention therapy. |
Abstract
Introduction: Obsessive-Compulsive Disorder (OCD) presents approximately 20% of cases refractory to conventional treatments, driving the investigation of pathophysiological pathways, including the glutamatergic hypothesis. In this context, ketamine emerges as a potential intervention. This study reviewed the literature on ketamine use in OCD, focusing on efficacy, mechanisms, and safety. Methodology: A narrative review was conducted in PubMed, Scopus, and Embase databases, covering publications from 2012 to 2025. Clinical trials and reviews evaluating ketamine or esketamine in adults with OCD were eligible. Ten studies obtained from the search (7 primary clinical trials, 1 preclinical study, and 2 systematic reviews).
Results: Evidence suggests that ketamine, predominantly at 0.5 mg/kg intravenously, promotes a rapid and clinically relevant reduction of obsessive-compulsive symptoms, acting within hours. However, the effect tends to be transient, returning to baseline around one week. Other routes of administration presented less consistent results.
Discussion: The acute response is compatible with rapid neuroplasticity mechanisms mediated by NMDA receptors, analogous to resistant depression. The short duration limits its use as a standalone monotherapy. There are indications of synergistic potential to facilitate Exposure and Response Prevention (ERP) therapy, leveraging a window of increased plasticity, although methodological limitations restrict generalization.
Conclusions: Ketamine is promising, yet experimental, for the acute management of OCD. It should not replace first-line treatments in routine practice. Its use must be restricted to specialized services and research contexts, requiring further trials to define maintenance and safety protocols.