Subanesthetic ketamine infusions have been shown to be a successful treatment of PTSD, obsessive-compulsive disorder (OCD) and other stress-related disorders including “burnout” syndrome and substance use disorders. Ketamine’s effectiveness for PTSD has been described elsewhere on our website. OCD is a disabling mental illness characterized by intrusive thoughts and compulsive repetitive behaviors which affects 1 in 100 adults. The condition typically begins in adolescence and early adulthood and can continue for the remainder of a patient’s lifetime. The impact of these compulsions and obsessive behaviors on the patient’s life can range from a moderate to severe disturbance of their daily activities and can become debilitating. Traditional treatments include pharmacotherapy with serotonin reuptake inhibitors (SRIs) and the use of cognitive behavioral therapy (CBT). Unfortunately, OCD symptoms respond incompletely to these therapies, and may take many months for significant improvement to occur. In patients who respond to SRIs, there is only a 20-40% reduction of symptoms on average, and treatment is fraught with multiple side effects, including but not limited to sexual dysfunction. CBT for OCD can take significant time to have an effect and leads to significant improvement in only 33-43% of patients. Because of the delay in treatment response, many patients drop out of therapy before completion. Recent studies have suggested that ketamine infusion therapy may bring about rapid and robust improvement of OCD symptoms, particularly when used in conjunction with CBT. Ketamine’s ability to alter glutamate and glutamine levels in parts of the brain associated with OCD is theorized to underlie its efficacy in this disorder.
Burnout syndrome shares many features with PTSD, differing largely in the degree of symptom severity. Both syndromes are maladaptive responses to a traumatic event or extreme stressor. Both are associated with feelings of fear, helplessness, or horror toward the event or stressor. Nightmares and sleep disturbances involving the trauma or stressor are common symptoms. Also, patients with PTSD and burnout suffer from increased frequency of depressive symptoms, withdrawal, mood swings and irritability. PTSD and burnout are hallmarked by avoidance of any situations that recall the trauma or stressor, and can lead problems with work, relationships and social activities. Substance abuse is a frequent complication, as the sufferer attempts to numb the mental anguish cause by these conditions. Unfortunately, traditional treatment of burnout centers around counseling which has variable efficacy and make take long periods of time to become effective. Given the painful symptoms of burnout and risk to professional and social relationships it causes, a more rapid and effective treatment strategy is needed. Recently, several clinics around the world have begun using subanesthetic ketamine infusions successfully to rapidly treat and improve the symptoms of burnout. This improvement is particularly robust and long-lasting when combined with CBT.
Substance use disorders shares similar stress-related triggers to PTSD and OCD, and many disease models suggest similar dysfunctions in the N-methyl-D- aspartate and glutaminergic systems as being behind the development of this condition. It appears that addictive disorders share neuroadaptations similar to those of depressive and anxiety disorders. Because of these similarities, it is theorized that ketamine may also be able affect the addictive disorders in a rapid and effective way. Psychedelic therapy with subanesthetic ketamine infusions has shown promise in the treatment of substance abuse disorder, particularly when combined with intensive rehabilitation and substance abuse counseling. However, higher dose IV ketamine infusions may also prove to be effective on their own. It appears the success of ketamine therapy may be related to the psychoactive effects of higher dosages, bringing about a deeply spiritual and transformational experience which allows the patient to reexamine his current life path, allowing the creation of new values, goals and strategies more conducive to a life of sobriety. Interestingly, even though ketamine has been widely abused recreationally, there is no evidence that ketamine infusions, when used as a supervised treatment for substance use disorders, are associated with future ketamine abuse, dependence or the triggering of other drug craving during or after the completion of therapy.