APA 2026 Recap: Ketamine, OCD, and What Psychiatry Discussed

TL;DR

The American Psychiatric Association held its yearly meeting in San Francisco this week — the biggest gathering of psychiatrists in the country. I attended. Here's what stood out, in plain English:

• Standard antidepressants haven't gotten meaningfully better in 40 years. Even today's newest medications work only modestly better than a placebo (sugar pill). The field said this out loud, on stage.
• Patients know this. Psychiatrists underestimate how much patients know. In one survey, 30% of patients said they were frustrated with their antidepressant. Psychiatrists guessed 11%. That gap matters.
• Ketamine is no longer a last resort. In the standard treatment plan that psychiatrists teach and follow, ketamine now sits in the middle of the list — not at the bottom. That's a real shift from five years ago.
• A Stanford researcher presented new data on ketamine for OCD. A single dose helped many patients dramatically reduce their obsessive-compulsive symptoms — with the effect lasting up to three weeks.
• The Director of NIDA (Nora Volkow) made the case for psychedelics in addiction treatment. Psilocybin trials show 6x higher smoking-cessation rates than the nicotine patch, and ~2.4x fewer heavy drinking days than control in alcohol use disorder. She emphasized: classic psychedelics work differently from addictive substances and aren't themselves addictive.
• The biggest question now isn't "does this work?" It's "how do we get it to everyone who needs it?" Access — not evidence — is the bottleneck.

I'm Mai Shimada, MD — a board-certified physician and the founder of Isha Health, where we deliver physician-led ketamine therapy at home. These are my notes from the meeting, written for patients and families trying to make sense of all this.

What is the APA meeting and why does it matter?

The American Psychiatric Association (APA) is the main professional organization for psychiatrists in the United States. Once a year, about 14,000 of them gather — this year in San Francisco — to share research, hear about new treatments, and argue about what's working and what isn't.

If you've ever wondered what your psychiatrist would know about new treatments if they had the time to keep up, this is where that information enters the system. So when the field publicly admits something on this stage — like "our standard medications haven't improved in 40 years" — it's worth paying attention to.

Finding #1: The honest conversation about antidepressants

Michael Thase, a professor of psychiatry at Penn and a leading researcher in depression for four decades, gave a talk that included a chart I think every patient on an antidepressant deserves to see.

Across three generations of antidepressants (the 1980s tricyclics, the 1990s SSRIs like Prozac and Zoloft, and the 2000s SNRIs like Effexor and Cymbalta), the response rate has barely moved:

Era of antidepressant	How well the drug worked	How well the placebo (sugar pill) worked
1980s	55%	33%
1990s	54%	37%
2000s	53%	41%

In every era, the drug works modestly better than a sugar pill — by about 10-15%. That gap hasn't grown despite billions of dollars of research and dozens of new drugs.

What this means for patients:

• Modern antidepressants are real medicines that help real people. About one in three patients who try one will reach remission (meaning their depression effectively goes away).
• But they're not the breakthrough patients are often led to believe they are. The advantage over a placebo is smaller than the marketing suggests.
• If you've tried an antidepressant and felt it didn't move the needle as much as you hoped — the data agrees with your experience. You are not alone, and you are not the problem.

Thase also walked through the practical limits patients run into:

• Slow: they take weeks to start working
• Often poorly matched: there's no reliable way to predict which medication will help which patient
• Side effects: about 10% of people stop because the side effects are intolerable
• Inconsistent on key symptoms: even when they help mood, they often don't help anxiety or sleep
• A lot of people don't respond at all: 20-30% of patients don't get meaningful relief from multiple antidepressant trials

This is the most honest summary of the limits of standard antidepressant therapy I've heard at a major medical meeting. It's not a takedown of medications — they remain useful tools. It's a recognition that for a large minority of patients, they aren't enough.

Finding #2: Patients know this. Doctors underestimate how much patients know.

The slide that stayed with me longest was a comparison of two surveys:

• Survey of 2,096 patients on antidepressants: 30% reported being frustrated with their medication. 27% felt hopeless. 27% felt apprehensive, anxious, or scared about it. 25% felt dissatisfied.
• Survey of psychiatrists: asked to estimate, the doctors guessed that only 11% of their patients were frustrated.

A nearly three-fold underestimate.

I feel this gap a lot when I talk with patients who've been through years of traditional psychiatric treatment. People arrive in a kind of quiet exhaustion — they've been told "give it more time" or "let's try the next one" so often that they've stopped expecting anything different. The number of patients who are politely tolerating a treatment that isn't really working is much higher than most psychiatrists realize. — Dr. Mai Shimada

This isn't anybody's fault individually. Visits are short. Patients want to be polite. Doctors have many patients. But the consequence is that a lot of suffering is invisible to the system that's supposed to be treating it.

If you've ever wondered whether your psychiatrist really understands how much your treatment isn't working, you're probably right to wonder.

Finding #3: Ketamine has moved into the mainstream treatment plan

The most important conceptual shift I noticed: ketamine is no longer being talked about as fringe or experimental.

Thase presented the standard treatment "ladder" that psychiatrists are taught to follow when a patient isn't responding to depression treatment. Here's a simplified version:

Step	What it means in plain English
Step 1	First antidepressant — usually an SSRI like Prozac, Zoloft, Lexapro
Step 2	Switch to a different antidepressant if step 1 didn't work
Step 3	Combine medications, try older drugs, or add Spravato (esketamine nasal spray)
Step 4	Brain stimulation therapies (TMS, ECT), or ketamine IV infusions
Step 5	Vagus nerve stimulation, experimental treatments

Five years ago, ketamine and esketamine were usually framed as "last-resort." Today, they're Step 3 or Step 4 in the standard treatment ladder — alongside or ahead of well-established therapies like TMS and ECT.

What this means for patients:

• If you've tried two antidepressants and they haven't helped, ketamine therapy is now a mainstream "what's next" option — not a desperate gamble.
• The medical establishment has caught up with what ketamine clinics have been seeing for years: this isn't fringe medicine.
• You don't need to "fail" 5 or 6 medications to be a reasonable candidate.

Finding #4: Doctors are starting to call it something different

A related conversation: psychiatrists have for decades used the term "Treatment-Resistant Depression" (or TRD) to describe patients who haven't responded to multiple antidepressants. At this meeting, there was growing support for a new term: "Difficult-to-Treat Depression" (DTD).

The reasoning, in plain language:

• "Treatment-resistant" sounds like the patient is the problem — as if their depression is fighting back against the medicine
• It frames depression as a battle that someone is "losing"
• It makes patients feel they've failed when really the treatment didn't work
• "Difficult-to-treat" puts the difficulty where it belongs: on the illness and the limits of current treatments, not on the person

This is a language shift, not a treatment shift. But language shapes how patients are treated and how they feel about themselves. If you've been called "treatment-resistant," that's a description of your medical history — not a verdict on you.

Finding #5: Big news on ketamine for OCD

The freshest data point I encountered came from Carolyn Rodriguez, who runs the OCD research lab at Stanford. She presented results from a study that hasn't been published yet — meaning APA attendees got this information weeks or months before it'll appear in any journal.

The study: 45 adults with moderate-to-severe OCD, none of whom were on other psychiatric medications. They were randomly assigned to receive either:

• A single 40-minute IV infusion of ketamine, or
• A single 40-minute IV infusion of midazolam — a different sedative drug, used as a comparison so that researchers could tell whether any benefit was specific to ketamine or just from "feeling something"

About 7 in 10 of these patients had already tried at least one OCD medication and it hadn't helped. About 4 in 10 had also done cognitive-behavioral therapy with exposure work. These were people for whom the standard playbook hadn't worked.

What happened:

OCD severity is measured on a scale called the Y-BOCS (Yale-Brown Obsessive-Compulsive Scale), which runs from 0 to 40. Severe OCD typically scores 24 and above; moderate OCD is in the high teens.

Time	Ketamine group	Midazolam group
Baseline (before infusion)	26 (severe)	26 (severe)
1 day after infusion	14 (mild)	22 (still severe)
1 week after infusion	17	24
3 weeks after infusion	21	25

In other words: a single ketamine infusion dropped severe OCD symptoms to mild levels within 24 hours, and a substantial portion of that improvement was still holding three weeks later. The comparison group didn't get the same benefit.

Some patient quotes from earlier studies in Rodriguez's lab capture what this looked like:

"I feel as if the weight of OCD has been lifted. I want to feel this way forever."

"I tried to have OCD thoughts but I couldn't."

"I don't have any intrusive thoughts. I was laughing when you couldn't find the key, which normally is a trigger for me. This is amazing, unbelievable."

What this means for patients:

• OCD has historically been one of the hardest mental health conditions to treat. The standard medications (SSRIs at high doses) help some people but leave many without enough relief.
• This new data is the strongest controlled evidence yet that ketamine can rapidly reduce obsessive-compulsive symptoms — including in people who haven't responded to standard treatments.
• It's not a cure. The benefits faded somewhat over 4 weeks. But a single supervised session producing weeks of relief is a meaningful new option.
• Ketamine is not currently FDA-approved for OCD. It is approved for general anesthesia, and Spravato (esketamine) is approved for treatment-resistant depression. So OCD treatment with ketamine is currently used "off-label" — meaning legally prescribable by a physician, but not a labeled indication.

Rodriguez was honest about the study's limitations — particularly that 87% of patients correctly guessed they had received ketamine because of its dissociative effects (a brief feeling of being detached during the infusion), which makes a true placebo comparison difficult. But the size of the effect makes it hard to explain by expectation alone.

Finding #6: Psychedelics for addiction — Nora Volkow's case

The single most-attended session of the meeting was a special talk by Nora Volkow — the Director of the National Institute on Drug Abuse (NIDA), the federal agency that funds nearly all U.S. addiction research. The session overflowed its assigned room and had to be broadcast to a second hall on another floor.

Volkow's case, in plain language: psychedelics may help with addiction in ways that current medications don't. And unusually for a federal agency director, she said it with data.

A few studies she walked through:

Psilocybin for alcohol use disorder. In a 2022 trial (Bogenschutz et al., JAMA Psychiatry), 95 adults with alcohol dependence were randomly given either psilocybin or an inactive comparison drug (diphenhydramine — Benadryl) as part of a structured therapy program:

• The psilocybin group spent 9.7% of days drinking heavily
• The comparison group spent 23.6% of days drinking heavily
• A more than two-fold difference, sustained over 32 weeks

Psilocybin for smoking cessation. In a 2026 Johns Hopkins trial (Johnson et al., JAMA Network Open), psychiatrically healthy smokers were randomly given either a single high-dose psilocybin session or an 8-10 week course of the standard nicotine patch:

• Psilocybin group: 40.5% prolonged abstinence at 6 months
• Nicotine patch group: 10.0%
• Psilocybin recipients were 6 times more likely to be off cigarettes at follow-up

Psilocybin for cocaine use disorder. Hendricks et al., 2026 (JAMA Network Open) — a single psilocybin session combined with therapy produced a 29% increase in cocaine-abstinent days compared to active control over 6 months, with significantly reduced risk of relapse.

What Volkow emphasized — and this is the line worth holding onto: classic psychedelics like psilocybin "work on neurotransmitter systems unrelated to the drug in question, don't operate through dopaminergic [addictive] effects, and are not themselves addictive." They are not stimulants. They don't replace one addiction with another. They appear to do something different — possibly resetting the brain circuits that drive compulsive drug use.

She was also honest about the limitations. The "mystical experience" that often accompanies a psilocybin session correlates with how well treatment works — but whether that subjective experience is actually necessary, or just incidental, is an active research question. Some researchers are developing non-hallucinogenic psychedelics ("psychoplastogens") that produce the brain-circuit changes without the trip. We don't yet know if those will work.

A bigger-picture signal from Volkow: recreational psychedelic use is rising sharply. Among adults aged 35-50, past-year hallucinogen use has gone from 0.5% in 2008 to 2.5% in 2022 — a five-fold increase. The conversation about regulation, safety, and integration into clinical care is happening now, whether the field is ready or not.

For patients struggling with addiction — particularly alcohol, nicotine, or stimulant use disorder — this is the part of psychiatric research moving fastest. Treatment-grade psilocybin isn't yet legally available in most of the country (Oregon and Colorado are the exceptions), but the regulatory pathway is moving. Ketamine for alcohol use disorder is also being studied and may reach broader access first.

Finding #7: The conversation has shifted from "does this work?" to "how do we scale it?"

A Sunday-afternoon panel made this explicit. Four operators — running practices and digital mental health companies — talked about the actual barriers to getting interventional treatments like ketamine and TMS to more patients. The honest summary:

• The evidence is here. The field is no longer debating whether these treatments work for the right patients.
• The bottleneck is access. Most patients who could benefit from ketamine therapy can't find it in their area, can't afford the in-clinic format, can't get insurance to cover it, or don't know it exists.
• Telehealth delivery is one of the answers. Remotely-supervised at-home protocols can reach people that in-clinic infusion centers never will.

This is what we do at Isha Health. It's encouraging — and a little vindicating — to hear the establishment publicly acknowledge that the delivery model is the next frontier, not the medicine itself.

So what should you take from this?

If you're a patient, a family member, or someone navigating depression or anxiety treatment, here's the most honest summary I can offer from a week of professional conversations:

1. If standard antidepressants haven't worked well for you, you're in the majority — not the minority of "difficult" patients. Roughly two-thirds of people don't reach remission with their first antidepressant, and a quarter to a third don't respond well to multiple trials. The system has been honest about this; it just doesn't always reach patients.

2. Ketamine therapy is not a last resort. In the treatment plan the field actually teaches, it sits in the middle of the list — alongside therapies like TMS that have been mainstream for years. For someone who's tried two antidepressants without enough benefit, ketamine is a reasonable next conversation, not a desperate one.

3. The evidence is broadening beyond depression. Carolyn Rodriguez's OCD data is the latest example of ketamine showing benefit in a condition where standard care leaves many patients stuck. Anxiety, PTSD, and other indications are being studied in parallel.

4. Access matters more than novelty. The treatments that will help the next million patients won't be brand-new molecules — they'll be existing treatments delivered in ways that more people can actually reach. That's the part of the conversation I'm most committed to.

If you've been wondering whether ketamine therapy might fit your situation, the most useful next step is a conversation with a physician who can review your specific history. At Isha Health, an initial consultation is a 60-minute video visit with a physician. We'll work through your history, your prior treatments, what's worked and what hasn't, and whether at-home ketamine therapy is a reasonable next step based on the framework the field outlined this week.

For readers who want to dig deeper

The research and surveys referenced above:

• Thase ME. CNS Spectrums 2017 — Treatment-resistant depression: review of the evidence
• Mago R et al. BMC Psychiatry 2018 — Patients' emotions about depression medications
• McAllister-Williams RH et al. J Affect Disord 2020 — The identification, assessment and management of difficult-to-treat depression
• Berman RM et al. Biological Psychiatry 2000 — The first controlled trial of ketamine for depression
• Zarate CA et al. Archives of General Psychiatry 2006 — Rapid antidepressant response in treatment-resistant depression
• Rodriguez CI et al. Neuropsychopharmacology 2013 — First randomized controlled trial of ketamine for OCD
• Rodriguez CI et al. American Journal of Psychiatry 2011 — First case report of ketamine's anti-obsessional effects
• Aaronson ST et al. American Journal of Psychiatry 2017 — 5-year observational study of VNS for treatment-resistant depression
• Conway CR et al. Brain Stimulation 2025 — RECONCILE: VNS in treatment-resistant depression (n=493)
• Bogenschutz MP et al. JAMA Psychiatry 2022 — Psilocybin-assisted therapy for alcohol use disorder
• Johnson MW et al. JAMA Network Open 2026 — Psilocybin vs. nicotine patch for smoking cessation
• Volkow ND, Gordon JA, Wargo EM. JAMA Psychiatry 2023 — Psychedelics in psychiatry: future directions
• Goodwin GM et al. New England Journal of Medicine 2022 — Single-dose psilocybin for treatment-resistant depression (n=233)
• FDA approval announcement — Spravato (esketamine) nasal spray for TRD, March 2019

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Related articles

• How does ketamine work? — A patient-friendly explanation of why this medication produces rapid mood improvements
• Racemic vs S-Ketamine vs R-Ketamine: Key Differences — The different forms of ketamine and which ones doctors use for what
• Spravato vs Ketamine Infusion: Cost & Effectiveness — How the FDA-approved nasal spray compares to IV ketamine

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