Tiagabine augmentation to fluvoxamine-risperidone combination in the treatment of obsessive-compulsive disorder.
Despite the recent progress in the pharmacological treatment of obsessive-compulsive disorder (OCD)--especially with high doses of serotonin reuptake inhibitors, alone or in combination with low doses of antipsychotics--a non-negligible proportion of patients remains refractory to it. For these patients augmentation tactics with drugs from other chemical classes, including antiepileptic drugs, seems advisable. We report on the case of a female inpatient with OCD, whereby the adjunction of tiagabine, a selective GABA reuptake inhibitor at 15 mg/day, to a fluvoxamine (400 mg/day)-risperidone (1 mg/day) combination led to the patient's marked improvement as reflected in the reduction by almost 47% of her score on the Yale-Brown Obsessive Compulsive Scale. With respect to tiagabine's specifically anti-OCD mechanism of action, we note that enhanced inhibitory GABAergic neurotransmission slows down excitatory glutamatergic transmission in the cortico-striato-thalamic system, which presumably constitutes the core pathophysiological mechanism of OCD symptoms.
Oulis
Panagiotis
P
Athens University Medical School, Department of Psychiatry, Eginition Hospital, Athens, Greece. oulisp@med.uoa.gr
Masdrakis
Vasilios G
VG
Karapoulios
Evangelos
E
Karakatsanis
Nikolaos A
NA
Kouzoupis
Anastasios V
AV
Konstantakopoulos
George
G
Soldatos
Constantin R
CR
D000328:Adult; D004338:Drug Combinations; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D016666:Fluvoxamine / Q000378:metabolism* / Q000627:therapeutic use*; D018755:GABA Agonists / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D009557:Nipecotic Acids / Q000494:pharmacology* / Q000627:therapeutic use*; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy*; D018967:Risperidone / Q000378:metabolism* / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000378:metabolism* / Q000627:therapeutic use*; D000078308:Tiagabine
D004338:Drug Combinations; D016666:Fluvoxamine; D018755:GABA Agonists; D009557:Nipecotic Acids; D018967:Risperidone; D017367:Selective Serotonin Reuptake Inhibitors; D000078308:Tiagabine