Ketamine for OCD: Is It the Right Next Step?

Disclaimer: I am not a prescriber and do not prescribe or recommend medications. The decision to use ketamine for OCD should be made in conjunction with a licensed psychiatric med prescriber. Research on ketamine treatment for OCD is new and emerging.

You're Starting to Lose Hope

If you’ve been working hard in therapy for OCD—especially with Exposure and Response Prevention (ERP)—but still feel like some symptoms are hanging on, you’re not alone. Many people with OCD hit a point where they feel better but not fully free. At that point, it’s normal to wonder: Is there anything else that could help?

One promising (but still emerging) option is ketamine treatment. But... what even is ketamine treatment? Is it safe? Is it for OCD? How do you do it? How does it stack up against other medications?

What Is Ketamine Treatment?

Ketamine is a medication that has been used safely for decades as an anesthetic. More recently, it’s been explored as a fast-acting treatment for depression, anxiety, PTSD, and OCD. Unlike SSRIs (which primarily target serotonin), ketamine acts on the brain’s glutamate system, which plays a big role in how rigid or flexible our thought patterns are.

In OCD, where the brain often gets stuck in obsessive-compulsive loops, ketamine’s ability to "disrupt" rigid patterns offers hope for people who haven’t gotten full relief with traditional treatments.

How Is Ketamine Given?

There are a few main ways ketamine treatment is delivered:

• IV Infusions: The most common method for OCD. You receive a controlled dose through an IV at a medical clinic over about 40–60 minutes.

• Nasal Spray (Spravato®/esketamine): FDA-approved for depression, used off-label for OCD. Administered under medical supervision.

• Lozenges or Oral Ketamine: Sometimes prescribed for at-home use, though less common and less research-supported for OCD.

Typically, a course of treatment might involve multiple infusions (often 6–8) over a few weeks, followed by maintenance doses if needed.

Pros and Cons of Ketamine for OCD

✅ Pros

• Fast-acting: Some people notice relief within hours or days, compared to the weeks or months it can take with SSRIs.

• Effective for suicidality: One of the most agreed upon effects of ketamine is reducing suicidal ideation which often shows up in treatment resistant OCD cases.

• Different mechanism: Helpful if serotonin-based treatments haven’t worked.

• Disrupts rigid thinking: Can temporarily make obsessive loops less "sticky," opening a window for deeper therapy work.

• Low physical addiction risk: When done medically and responsibly, the risk of dependence is low.

⚠️ Cons

• Temporary relief: Benefits can fade unless combined with ERP therapy or booster treatments.

• Side effects: Some people experience nausea, dizziness, dissociation (feeling disconnected from reality), or blood pressure spikes during treatment.

• Cost: Often expensive ($400–$800 per infusion) and not always covered by insurance.

• Not a standalone cure: Works best when integrated with continued therapy, not as a replacement for it.

  
  
  
  

Ketamine vs. SSRIs for OCD: A Quick Comparison

If you’ve never tried SSRIs and your OCD is still moderately severe, they’re typically considered the first medication step. But if you’ve already made solid gains with ERP and still feel "stuck" mainly in mental compulsions or lingering obsessions, ketamine might be worth exploring.

Decision-Making Guidelines: Is Ketamine Right for You?

Here’s a quick checklist you can use:

✅ You’ve done a strong course of ERP but still have distressing mental compulsions or obsessive loops

.✅ You’ve tried SSRIs or other meds and didn’t get full relief—or you had intolerable side effects.

✅ You’re prepared to combine ketamine with therapy to maximize and sustain gains.

✅ You have access to a reputable clinic that offers supervised ketamine infusions or Spravato treatment.

✅ You’re aware of the costs and ready for a short-term, intensive treatment period.

Final Thoughts

Ketamine isn’t a magic bullet—but it can be a powerful tool when used thoughtfully, especially for people who have already done serious work in therapy. It opens a window for flexibility and change, but it’s what you do during and after that window (like resisting compulsions and practicing ERP) that leads to real, lasting progress.

If you’re feeling curious or hopeful about it, that’s a good thing. You deserve to feel as free from OCD as possible. Whether it’s ketamine, SSRIs, therapy, or a combination of all three, your healing path is allowed to be multi-layered.