Clinical case report: considerable improvement of severe and difficult-to-treat obsessive-compulsive disorder with comorbid depression under treatment with esketamine and concomitant psychotherapy.
Frontiers in psychiatry January 1, 2023 Alexander Kaltenboeck, Elisa Foerster, Sabrina Strafner et al.
A 28-year-old man with severe obsessive-compulsive disorder (OCD) and depression, who had not responded to cognitive-behavioural therapy, selective serotonin reuptake inhibitors, clomipramine, or antipsychotics, received off-label esketamine combined with psychotherapy. Over about 2 months he had 10 esketamine-plus-psychotherapy sessions, then two maintenance sessions, and later continued maintenance esketamine every 4-6 weeks with independent cognitive-behavioural therapy. His OCD symptoms improved markedly (Y-BOCS fell from >35 before treatment to 23 at week 8 and 14 at week 26), and depressive symptoms also decreased (MADRS fell from 47 before treatment to 12 at week 9 and 3 at week 26). At week 66, OCD symptoms remained mild (Y-BOCS 13) and depression was in remission (MADRS <6). This case suggests esketamine plus psychotherapy may be promising for difficult-to-treat OCD and depression.