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

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To the Editors
Refractory obsessive-compulsive disorder (OCD) is a common and vexing clinical problem. Agents that modulate glutamate, including the N-methyl-D- aspartate antagonist ketamine, have been the focus of recent interest for the treatment of this population,1 but experience to date has been mixed.2,3 Ketamine is a rapid-acting antidepressant that enhances cellular mechanisms associated with neural plasticity in prefrontal circuitry associated with extinction learning.4 This raises the intriguing possibility that ketamine may potentiate extinction-based psychotherapy for OCD.

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