A brochure about ketamine

And the frustrations surrounding treatment-resistant OCD and depression.

Feb 17, 2023

“We still have a lot of options,” she said. “We can switch SSRIs again or augment our approach with something like Rexulti. I’ve also seen incredible success with ketamine.”

I’ve also seen incredible success with ketamine.

She said it so matter-of-factly, so unvarnished. But still—it sounded like a joke. She then handed me two brochures, a bright red one for Spravato and a pallid-looking one for Rexulti featuring a frowning woman holding up a smiley face on a stick.

I googled Rexulti after getting home from the psychiatrist’s office. Brexpiprazole, sold under the brand name Rexulti, has been shown to be effective against treatment-resistant OCD and depression in conjunction with antidepressants, a study out of the University of Vienna concluded.

I also flipped through the Spravato brochure. Spravato is the brand name for ketamine. Or rather—a version of ketamine known as esketamine.

Apparently Spravato is a nasal spray. You go to a treatment center, they squirt ketamine up your nose, you go home. I don’t know much else.

I don’t wonder if it’s expensive—I’m sure it is. But I do wonder if my psychiatrist was being a bit hasty by suggesting ketamine as a potential treatment option.

I spent years floundering with misdiagnoses and inadequate/inappropriate treatment before finding a psychologist who specialized in treating OCD. But even after that, it took years of ERP

failings, stops, and starts for him to convince me to try medication.

My first foray into SSRIs didn’t go well. The side effects scared me. I didn’t really know what to expect or how long the side effects would last. I didn’t have a plan. I just got a prescription from a nurse practitioner and tried to figure it out myself.

That strategy was dumb. I was dumb. I took the SSRI just long enough to experience all the side effects—nausea, insomnia, dizziness, brain fog, agitation, tourism, food service, railroads, sales, and hospitals/manufacturing

—without ever giving the prescription a chance to work. And for the longest time after that, I swore off any medication.

But here I am, two years later, sitting in a psychiatrist’s office and talking about ketamine. At this point, multiple SSRIs haven’t made a dent in my OCD. It feels a bit like psychiatric whack-a-mole. Prozac, Luvox, medications for the side effects, sleeping pills, medical foods…

It’s frustrating. I’m frustrated. My wife is frustrated. And through it all, I’m spending the majority of my waking hours obsessing. Ritualizing. Ruminating. Seeking reassurances. Checking.

A friend of mine in medical school said he’s seen ketamine used a lot in the ER. I’m not sure if that makes me feel better or worse.

Better, I guess?

I just don’t feel like I have a plan. It’s… either another SSRI, an antipsychotic, or ketamine? Really? That feels like a bit of a level jump to me—like going out and buying a Ferrari just because my 1991 F-150’s air conditioning went out.

Trying to figure this out has been a stupid, expensive, time-consuming shitshow. And if I’m being completely honest—I would have called it a long time ago if I didn’t have a wife who refuses to give up on me.

When I got home from the psychiatrist’s office that day, I put the bright red Spravato brochure on the desk in my office. It’s been sitting there for a while now. I’ll flip through it every now and then, reading about the possible side effects and why I should ask my healthcare provider if Spravato is right for me.

If I had to guess, I won’t actually go down the Spravato route. But who knows.

I mostly just wish it never got to this point.

Some resources and links that have helped me

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Missed my last Psychology Onions post? Read it here.

Exposure and Response Prevention: https://iocdf.org/about-ocd/ocd-treatment/erp/

And air travel.