Clinical case report: considerable improvement of severe and difficult-to-treat obsessive-compulsive disorder with comorbid depression under treatment with esketamine and concomitant psychotherapy

Alexander Kaltenboeck; Elisa Foerster; Sabrina Strafner; Ulrike Demal; Nilufar Mossaheb; Fabian Friedrich

doi:10.3389/fpsyt.2023.1291077

Clinical case report: considerable improvement of severe and difficult-to-treat obsessive-compulsive disorder with comorbid depression under treatment with esketamine and concomitant psychotherapy

Front Psychiatry. 2023 Nov 28:14:1291077. doi: 10.3389/fpsyt.2023.1291077. eCollection 2023.

Authors

Alexander Kaltenboeck^#¹, Elisa Foerster^#¹, Sabrina Strafner^{1

2}, Ulrike Demal^{1

2}, Nilufar Mossaheb¹, Fabian Friedrich¹

Affiliations

¹ Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
² Division of Clinical Psychology and Psychotherapy, Medical Head Office (Ärztliche Direktion), University Hospital Vienna, Vienna, Austria.

^# Contributed equally.

Abstract

A 28-year-old man was admitted to our psychiatric ward with severe obsessive-compulsive disorder (OCD) and comorbid depression. At intake, obsessive-compulsive symptoms were present most time of the day and were related to an intense fear of causing interpersonal misunderstandings. Various treatment attempts, including cognitive-behavioural therapy (CBT) with exposure and response prevention (ERP), selective serotonin reuptake inhibitors, clomipramine, and add-on antipsychotics were either ineffective and/or were not tolerated, and the patient's condition worsened progressively. Following an in-depth multidisciplinary team discussion and a shared decision-making process, an off-label treatment trial with esketamine and concomitant psychotherapy was started. The patient received 10 esketamine + psychotherapy sessions over a period of about 2 months, followed by two maintenance sessions in about 3-week intervals. After this, he was discharged into regular outpatient care where he continued to receive maintenance esketamine treatment every 4-6 weeks and, independent of this, individual CBT. Following the establishment of esketamine with concurrent psychotherapy, the patient exhibited a remarkable clinical improvement. Obsessive-compulsive symptoms showed a clear and sustained response (Y-BOCS before treatment >35, Y-BOCS at week 8 = 23, Y-BOCS at week 26 = 14). Paralleling this, depressive symptoms also decreased (MADRS before treatment = 47, MADRS at week 9 = 12, MADRS at week 26 = 3). At a naturalistic follow-up at week 66, obsessive-compulsive symptoms were still mild (Y-BOCS = 13), and depression was still in remission (MADRS < 6). This clinical case suggests that (es)ketamine plus concomitant psychotherapy may hold promise as a therapeutic strategy for difficult-to-treat OCD and depression and its full clinical potential should be evaluated in more comprehensive future studies.

Keywords: case report; depression; ketamine; ketamine-assisted psychotherapy; obsessive-compulsive disorder.

Publication types

Case Reports

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.