Ketamine Infusion for Obsessive-Compulsive Disorder
Study Details
Study Description
Brief Summary
Roughly one-third of patients with obsessive-compulsive disorder (OCD) do not experience significant clinical benefit from first-line interventions such as pharmacotherapy with selective serotonin reuptake inhibitors (SSRI) or cognitive behavioral therapy (CBT). Furthermore, OCD patients typically experience the full treatment benefits of first-line interventions only after a time-lag of two to three months. Inadequate symptom relief and delay of symptom relief from first-line treatments are sources of substantial morbidity and decreased quality of life in OCD patients. Converging lines of evidence from neuroimaging, genetic and pharmacological studies support the importance of glutamate abnormalities in the pathogenesis of OCD.
The investigators are conducting an open, uncontrolled study of ketamine in treatment-refractory OCD. Ketamine is a potent antagonist of the N-methyl-D-aspartate (NMDA) receptor and has been demonstrated to have rapid anti-depressant effects in patients with Major Depressive Disorder. The investigators have additionally provided evidence for rapid improvement of comorbid OCD and trichotillomania after ketamine infusion in a depressed woman.
Failure of symptom relief and delay of symptom relief from first-line treatments are a source of substantial morbidity and decreased quality of life in OCD patients. Ketamine represents the possibility to provide rapid symptom relief to OCD patients and may provide the mechanism for future drug development to treat OCD more rapidly and effectively.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
Phase 2 |
Detailed Description
Roughly one-third of patients with obsessive-compulsive disorder (OCD) fail to experience significant clinical benefit from first-line interventions such as pharmacotherapy with selective serotonin reuptake inhibitors (SSRI) or cognitive behavioral therapy (CBT). Antipsychotic augmentation is the only pharmacological strategy for treatment-refractory OCD with demonstrated efficacy in multiple double-blind trials (2). Antipsychotic augmentation only benefits around 1 in 3 treatment-refractory OCD. Furthermore, OCD patients typically experience the full treatment benefits of first-line interventions only after a time-lag of two to three months. Failure of symptom relief and delay of symptom relief from first-line treatments are sources of substantial morbidity and decreased quality of life in OCD patients.
Converging lines of evidence from neuroimaging, genetic and pharmacological studies support the importance of glutamate abnormalities in the pathogenesis of OCD. In Magnetic Resonance Spectroscopy studies elevated concentrations of glutamate and related compounds have been demonstrated in the caudate nucleus and orbitofrontal cortex of OCD patients compared to normal controls. In genetic studies, single nucleotide polymorphisms within the glutamate transporter gene SLC1A1 have been associated with the diagnosis of OCD. Open-label, pharmacological treatment studies have suggested that glutamate modulating agents such as riluzole, n-acetylcysteine and memantine may be effective in the treatment of OCD.
Ketamine is a potent antagonist of the N-methyl-D-aspartate (NMDA) receptor, a major type of glutamate receptor in the brain. In a placebo-controlled study completed at Yale a single dose of ketamine (0.5 mg/kg, intravenously) had rapid antidepressant effects in depressed patients. In these subjects ketamine infusion produced mild psychotomimetic symptoms and euphoria that dissipated within 120 minutes, while the antidepressant effects of ketamine infusion emerged over the first 180 minutes and persisted over 72 hours. Fifty percent of depressed patients receiving ketamine were treatment responders at Day 3 compared to 12.5% in the placebo infusion group. These results have been replicated in a recent double-blind study performed at NIMH and a third unpublished study conducted by members of our group at Yale.
Our goal is to conduct an open-label study in treatment-refractory OCD to determine if ketamine may be an effective acute anti-obsessional agent.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Ketamine Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. |
Drug: ketamine
Ketamine (a single 0.5mg intravenously over 40 minutes).
|
Outcome Measures
Primary Outcome Measures
- OCD Severity [Baseline and 1 day after ketamine infusion]
We will examine change from baseline in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ratings of OCD severity at 1 day following infusion. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) assesses obsessive and compulsive symptom severity. Obsessions are rated on a scale from 0-20 and compulsions are rated on a scale of 0-20, for a total scale of 0-40. Scores on the obsessions scale and scores on the compulsions scale are summed to obtain the total score. The higher the score, the more severe the OCD.
- OCD Severity [Baseline and 2 days following infusion]
We will examine change from baseline in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ratings of OCD severity at 2 days following infusion. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) assesses obsessive and compulsive symptom severity. Obsessions are rated on a scale from 0-20 and compulsions are rated on a scale of 0-20, for a total scale of 0-40. Scores on the obsessions scale and scores on the compulsions scale are summed to obtain the total score. The higher the score, the more severe the OCD.
- OCD Severity [Baseline and 3 days following infusion]
We will examine change from baseline in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ratings of OCD severity at 3 days following infusion. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) assesses obsessive and compulsive symptom severity. Obsessions are rated on a scale from 0-20 and compulsions are rated on a scale of 0-20, for a total scale of 0-40. Scores on the obsessions scale and scores on the compulsions scale are summed to obtain the total score. The higher the score, the more severe the OCD.
Secondary Outcome Measures
- Depression Symptoms [Baseline, Day 1, Day 2, and Day 3]
We will examine change from baseline in Hamilton Rating Scale for Depression (HRDS) ratings of depression severity at day 1-3 following a single ketamine infusion. The HRDS assesses severity of, and change in, depressive symptoms. The HRDS is a 21 item scale with scores ranging from 0-66. The higher the score, the more severe the depression.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Adult between the ages of 18 and 65 years.
-
Meet DSM IV criteria for obsessive-compulsive disorder by structured clinical interview (SCID) and have a Y-BOCS score >24.
-
Have treatment-refractory OCD. Have Y-BOCS>24 despite two SSRI trials of adequate dose and duration and been offered prior CBT treatment.
-
Stable psychiatric medications. Subjects must have had stable doses of all psychiatric medications for the month prior to treatment and have been on stable doses of SSRI and clomipramine for at least 2 months prior to study enrollment.
-
Medically and neurologically healthy.
-
Able to provide written informed consent according to the Yale HIC guidelines.
Exclusion Criteria:
-
Lifetime history of substance dependence (other than nicotine and caffeine)
-
Suicide attempt or suicidal ideation requiring psychiatric hospitalization in the previous 6 months
-
Being Pregnant
-
Known hypersensitivity to ketamine
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Connecticut Mental Health Center/ YNHH | New Haven | Connecticut | United States | 06520 |
Sponsors and Collaborators
- Yale University
- National Alliance for Research on Schizophrenia and Depression
Investigators
- Principal Investigator: Michael H Bloch, MD, MS, Yale University
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 0901004660
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail |
Arm/Group Title | Ketamine |
---|---|
Arm/Group Description | Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. ketamine: Ketamine (a single 0.5mg intravenously over 40 minutes). |
Period Title: Overall Study | |
STARTED | 10 |
COMPLETED | 10 |
NOT COMPLETED | 0 |
Baseline Characteristics
Arm/Group Title | Ketamine |
---|---|
Arm/Group Description | Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. ketamine: Ketamine (a single 0.5mg intravenously over 40 minutes). |
Overall Participants | 10 |
Age (years) [Mean (Standard Deviation) ] | |
Mean (Standard Deviation) [years] |
41.7
(13.5)
|
Age (Count of Participants) | |
<=18 years |
0
0%
|
Between 18 and 65 years |
10
100%
|
>=65 years |
0
0%
|
Sex: Female, Male (Count of Participants) | |
Female |
4
40%
|
Male |
6
60%
|
Region of Enrollment (participants) [Number] | |
United States |
10
100%
|
Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (units on a scale) [Mean (Standard Deviation) ] | |
Mean (Standard Deviation) [units on a scale] |
32.9
(1.9)
|
Outcome Measures
Title | OCD Severity |
---|---|
Description | We will examine change from baseline in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ratings of OCD severity at 1 day following infusion. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) assesses obsessive and compulsive symptom severity. Obsessions are rated on a scale from 0-20 and compulsions are rated on a scale of 0-20, for a total scale of 0-40. Scores on the obsessions scale and scores on the compulsions scale are summed to obtain the total score. The higher the score, the more severe the OCD. |
Time Frame | Baseline and 1 day after ketamine infusion |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Ketamine |
---|---|
Arm/Group Description | Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. ketamine: Ketamine (a single 0.5mg intravenously over 40 minutes). |
Measure Participants | 10 |
Mean (Standard Deviation) [units on a scale] |
-2.7
(1.11)
|
Title | OCD Severity |
---|---|
Description | We will examine change from baseline in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ratings of OCD severity at 2 days following infusion. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) assesses obsessive and compulsive symptom severity. Obsessions are rated on a scale from 0-20 and compulsions are rated on a scale of 0-20, for a total scale of 0-40. Scores on the obsessions scale and scores on the compulsions scale are summed to obtain the total score. The higher the score, the more severe the OCD. |
Time Frame | Baseline and 2 days following infusion |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Ketamine |
---|---|
Arm/Group Description | Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. ketamine: Ketamine (a single 0.5mg intravenously over 40 minutes). |
Measure Participants | 10 |
Mean (Standard Deviation) [units on a scale] |
-3.6
(1.19)
|
Title | OCD Severity |
---|---|
Description | We will examine change from baseline in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ratings of OCD severity at 3 days following infusion. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) assesses obsessive and compulsive symptom severity. Obsessions are rated on a scale from 0-20 and compulsions are rated on a scale of 0-20, for a total scale of 0-40. Scores on the obsessions scale and scores on the compulsions scale are summed to obtain the total score. The higher the score, the more severe the OCD. |
Time Frame | Baseline and 3 days following infusion |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Ketamine |
---|---|
Arm/Group Description | Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. ketamine: Ketamine (a single 0.5mg intravenously over 40 minutes). |
Measure Participants | 10 |
Mean (Standard Deviation) [units on a scale] |
-2.9
(0.91)
|
Title | Depression Symptoms |
---|---|
Description | We will examine change from baseline in Hamilton Rating Scale for Depression (HRDS) ratings of depression severity at day 1-3 following a single ketamine infusion. The HRDS assesses severity of, and change in, depressive symptoms. The HRDS is a 21 item scale with scores ranging from 0-66. The higher the score, the more severe the depression. |
Time Frame | Baseline, Day 1, Day 2, and Day 3 |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Ketamine |
---|---|
Arm/Group Description | Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. ketamine: Ketamine (a single 0.5mg intravenously over 40 minutes). |
Measure Participants | 10 |
HRDS change from Baseline to Day 1 |
-6.57
(1.69)
|
HRDS change from Baseline to Day 2 |
-7.29
(2.89)
|
HRDS change from Baseline to Day 3 |
-5.14
(2.48)
|
Adverse Events
Time Frame | ||
---|---|---|
Adverse Event Reporting Description | ||
Arm/Group Title | Ketamine | |
Arm/Group Description | Ketamine will be given at a dose of 0.5mg/kg over 40 minutes. This dose is identical to that used in previous anti-depressant studies of ketamine. ketamine: Ketamine (a single 0.5mg intravenously over 40 minutes). | |
All Cause Mortality |
||
Ketamine | ||
Affected / at Risk (%) | # Events | |
Total | / (NaN) | |
Serious Adverse Events |
||
Ketamine | ||
Affected / at Risk (%) | # Events | |
Total | 0/10 (0%) | |
Other (Not Including Serious) Adverse Events |
||
Ketamine | ||
Affected / at Risk (%) | # Events | |
Total | 5/10 (50%) | |
General disorders | ||
Transient increase in systolic blood pressure | 1/10 (10%) | |
Psychiatric disorders | ||
Dysphoria | 2/10 (20%) | |
Dissociative symptoms | 5/10 (50%) | |
Anxiety | 2/10 (20%) | |
Passive suicidal ideation | 2/10 (20%) |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Name/Title | Dr. Michael Bloch, MD, MS |
---|---|
Organization | Yale University, Connecticut Mental Health Center |
Phone | 203-737-4809 |
michael.bloch@yale.edu |
- 0901004660