Carolyn Rodriguez Wins Prestigious Award for Innovative OCD Research

Rodriguez made the most of that opportunity, developing an early fascination with science and the biological basis of human behavior. Driven by a desire to solve challenging problems, she enrolled in an M.D./Ph.D. program in medicine, health science technology, and neuroscience after completing her undergraduate degree at Harvard (with a major in computer science).

A clinical encounter with an OCD patient early in her residency at Columbia University solidified her passion for helping patients through both clinical and research pathways. “I was immediately struck not only by his private suffering, but also by all of the physical manifestations that made his life harder,” she said. “His distressing intrusive thoughts about contamination caused him to always wear gloves when he went outside. He washed his hands excessively. When he took his hands out of his gloves, they were red and raw. His pain made a big impression on me.” As she treated more individuals with OCD, Rodriguez was frustrated by the current first-line OCD treatments like antidepressants and cognitive-behavioral therapy, which take two to three months before symptoms are substantially reduced and often leave patients with residual symptoms. Rodriguez felt an urgent need for more effective and faster-acting treatments for OCD, which led her to look for new strategies like ketamine.

Following that first successful infusion, Rodriguez and her team led the first proof-of-concept clinical trial comparing low-dose intravenous ketamine with placebo in 15 OCD patients suffering from constant obsessions. Within one week after a single ketamine infusion, half the patients met the response criterion for OCD symptom reduction. The effect was rapid (within hours), and patients reported remarkable benefit. As with studies that have tested ketamine as an antidepressant, though, not every patient responded and several patients also experienced side effects like a feeling of disssociation.

Rodriguez has therefore spent the past several years working toward understanding the mechanism of ketamine’s rapid action and testing other compounds to see whether any might produce better symptom improvements with fewer side effects. Her lab is preparing to start a clinical trial testing hydroxynorketamine, a metabolic byproduct of ketamine that, in mice at least, can improve depressive-like symptoms without ketamine-like side effects.

In parallel, Rodriguez and a team of interdisciplinary colleagues are testing transcranial magnetic stimulation (TMS), a noninvasive treatment with the advantage of not having systemic side effects that many drugs have. In a significant milestone, TMS was recently cleared by the FDA last year for treatment-resistant OCD. However, as with medications, TMS for OCD takes time—approximately six weeks. However, recent technological advances in the way TMS pulses are delivered have dramatically shortened the duration of individual treatment sessions, and Rodriguez’s team is now pilot testing whether a 50% reduction in OCD symptoms can be achieved in five days.

Rodriguez is also interested in hoarding disorder, which was added as a distinct diagnostic entity from OCD in DSM-5. People with hoarding disorder put themselves at risk due to unsafe conditions in the home that can cause falls, fires, and pest infestation. Rodriguez is exploring the use of virtual reality as a means to help patients practice decision making, uncluttering, and tolerating the difficulty parting with possessions in a safe environment.

“Looking back, having strong mentors and sponsors who were willing to support me and encourage high-risk ideas—despite the challenges and skepticism—made the difference,” Rodriguez told Psychiatric News.  ■