Esketamine (Spravato®) for OCD | Tampa & Wesley Chapel | Florida TMS Clinic

Why consider esketamine for OCD?

Many people with obsessive-compulsive disorder (OCD) respond to high-dose SSRIs, clomipramine, and exposure-and-response prevention (ERP) therapy. But when intrusive thoughts and compulsions persist despite best-practice care, clinicians may consider **glutamatergic strategies**. Esketamine (Spravato®) targets the NMDA receptor within the glutamate system—a pathway implicated in obsessive thinking, cognitive rigidity, and anxiety—offering a mechanistically distinct option from serotonin-based medications.

What the evidence shows (current, evolving)

  • Intranasal esketamine case series (adult TR-OCD + MDD): Over ~12 weeks, patients receiving 56–84 mg intranasal esketamine showed meaningful average reductions in OCD severity (Y-BOCS) and robust antidepressant effects; a subset met OCD response criteria. Effects on depression tended to appear earlier than OCD gains.
  • Retrospective augmentation data: In treatment-resistant OCD cohorts, off-label esketamine added to ongoing therapy was associated with symptom improvements for some patients, supporting feasibility and safety under clinic supervision.
  • Mechanistic/ketamine literature: Randomized crossover data with IV ketamine demonstrate rapid anti-obsessional effects, consistent with glutamatergic modulation of cortico-striato-thalamo-cortical circuits. Benefits may be amplified when paired with ERP to consolidate learning during heightened neuroplasticity.

Evidence is preliminary; larger, controlled trials are needed. We individualize decisions and track outcomes measurement-based.

Key takeaways

  • OCD response is possible but variable; depression often improves faster.
  • Best outcomes likely when esketamine is paired with ERP-based CBT.
  • Safety profile is generally transient: brief dissociation, dizziness, nausea, temporary BP increases—monitored on site.

If you are in an immediate crisis, call 988(Suicide & Crisis Lifeline) or 911.

How treatment works at Florida TMS Clinic

  • Eligibility & planning: Confirm diagnosis, prior trials (SSRIs/SRI, clomipramine, antipsychotic augmentation), ERP engagement, and medical suitability.
  • Program: Induction typically 2 visits/week for ~4 weeks, then taper to weekly/biweekly as appropriate. Dosing is individualized within the 56–84 mg range under REMS supervision.
  • Visit length: About 2 hours including administration, recovery, and monitoring (vitals, comfort).
  • Aftercare: No driving until the next day; arrange a safe ride.
  • Measurement-based care: We track Y-BOCS for OCD and depression scales to guide continuation.

Integrating therapy

We coordinate with your therapist to schedule ERP during the acute phase. Leveraging esketamine-related neuroplasticity may help patients resist compulsions and reinforce new learning.

Call (813) 867-2378 Ask About ERP Coordination

Esketamine vs. TMS for OCD — Which is Right for Me?

Both Transcranial Magnetic Stimulation (TMS) and Esketamine (Spravato®) are considered for complex OCD cases—especially when depression coexists. Many patients benefit from a sequenced or combined approach.

Who is a good candidate?

  • Adults with treatment-resistant OCD after optimized SSRI/SRI ± clomipramine and augmentation trials.
  • Active engagement (or readiness) for ERP-based CBT.
  • Co-occurring treatment-resistant depression(where Spravato® is on-label) is common and may strengthen the case for trial.
  • Medically appropriate for supervised intranasal therapy and follow-up.

Safety & monitoring

We’re a REMS-certified center. Common effects are transient (e.g., brief dissociation, dizziness, nausea, temporary BP increases) and resolve during on-site observation.

We’ll review risks, benefits, and alternatives and proceed only with shared decision-making.

Esketamine for OCD in Tampa & Wesley Chapel

Florida TMS Clinic — Tampa

Serving Tampa, South Tampa, Downtown, and Westshore. Same-week evaluations often available.

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Florida TMS Clinic — Wesley Chapel

Serving Wesley Chapel, New Tampa, Lutz, and Land O’ Lakes with convenient access and parking.

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Take the First Step

If best-practice OCD care hasn’t been enough, our team can evaluate whether an off-label esketamine trial makes sense—often in combination with ERP and, when appropriate, TMS.

Call (813) 867-2378 Request Appointment

Esketamine & OCD — FAQs

Is Spravato® FDA-approved for OCD?
No. It’s FDA-approved for treatment-resistant depression (TRD) and for depressive symptoms in MDD with acute suicidal ideation/behavior. OCD use is off-label and considered case-by-case after standard therapies are optimized.
How fast might OCD symptoms change?
Anti-obsessional effects can appear within days in some ketamine data, but OCD improvements with intranasal esketamine are often more gradual and heterogeneous—commonly emerging over weeks 8–12 in responders. Depression, if present, may improve sooner.
Do I still need ERP therapy?
Yes. We strongly recommend pairing esketamine with ERP to reinforce new learning during periods of increased neuroplasticity.
What are common side effects?
Transient dizziness, brief dissociation, nausea, and temporary blood-pressure increases. We monitor you throughout the visit, and you should not drive until the next day.
Can esketamine be combined with TMS?
Yes. For TRD + OCD, a combined or sequenced approach (Esketamine + TMS + ERP) may optimize speed and durability. We’ll individualize the plan.

Selected references (plain-language): Intranasal esketamine augmentation case series in treatment-resistant OCD with depression; retrospective clinic data; randomized crossover ketamine trial showing rapid anti-obsessional effects; safety reviews of esketamine/ketamine in supervised settings.