title: N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder.
abstract: 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.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Lafleur
authors.forename: Christopher
authors.initials: C
authors.lastname: Pittenger
authors.forename: Ben
authors.initials: B
authors.lastname: Kelmendi
authors.forename: Tom
authors.initials: T
authors.lastname: Gardner
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wasylink
authors.forename: Robert T
authors.initials: RT
authors.lastname: Malison
authors.forename: Gerard
authors.initials: G
authors.lastname: Sanacora
authors.forename: John H
authors.initials: JH
authors.lastname: Krystal
authors.forename: Vladimir
authors.initials: V
authors.lastname: Coric
mesh_terms: 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*
chemical_list: D000111:Acetylcysteine; D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors