N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder.
BACKGROUND
Dysfunction of glutamatergic neurotransmission has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD) and recent clinical reports suggest that some glutamate modulating agents are efficacious in the treatment of this disorder. N-acetylcysteine (NAC) is a readily available amino acid compound that is thought to attenuate glutamatergic neurotransmission. NAC may be useful in treating psychiatric disorders involving glutamatergic dysfunction such as OCD.


OBJECTIVE
To examine the efficacy of augmentation with NAC in a patient with serotonin reuptake inhibitor (SRI)-refractory OCD.


METHODS
A patient with SRI-refractory OCD was treated with an off-label use of NAC augmentation of fluvoxamine over several weeks.


RESULTS
NAC augmentation of fluvoxamine resulted in a marked decrease in Yale-Brown Obsessive Compulsive Scale (Y-BBOCS) score and a clinically significant improvement in OCD symptoms.


CONCLUSIONS
NAC augmentation was effective in treating SRI-refractory OCD in this single case. Further research is warranted to investigate the use of NAC and other glutamate modulating agents in the treatment of OCD.
Lafleur
Daniel L
DL
Pittenger
Christopher
C
Kelmendi
Ben
B
Gardner
Tom
T
Wasylink
Suzanne
S
Malison
Robert T
RT
Sanacora
Gerard
G
Krystal
John H
JH
Coric
Vladimir
V
D000111:Acetylcysteine / Q000627:therapeutic use*; D004351:Drug Resistance; D004357:Drug Synergism; D005260:Female; D016666:Fluvoxamine / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
D000111:Acetylcysteine; D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors