Glutamate-Modulating Drugs as a Potential Therapeutic Strategy in Obsessive-Compulsive Disorder.
OBJECTIVE
Obsessive-compulsive disorder (OCD) is a mental disease commonly associated with severe distress and impairment of social functioning. Serotonin reuptake inhibitors and/or cognitive behavioural therapy are the therapy of choice, however up to 40% of patients do not respond to treatment. Glutamatergic signalling has also been implicated in OCD. The aim of the current study was to review the clinical evidence for therapeutic utility of glutamate-modulating drugs as an augmentation or monotherapy in OCD patients.


METHODS
We conducted a search of the MEDLINE database for clinical studies evaluating the effect of glutamate-modulating drugs in OCD.


RESULTS
Memantine is the compound most consistently showing a positive effect as an augmentation therapy in OCD. Anti-convulsant drugs (lamotrigine, topiramate) and riluzole may also provide therapeutic benefit to some OCD patients. Finally, ketamine may be of interest due to its potential for a rapid onset of action.


CONCLUSIONS
Further randomized placebo-controlled trials in larger study populations are necessary in order to draw definitive conclusions on the utility of glutamate-modulating drugs in OCD. Furthermore, genetic and epigenetic factors, clinical symptoms and subtypes predicting treatment response to glutamate-modulating drugs need to be investigated systematically.
Department of Psychosomatic Medicine, Clinic Barmelweid, 5017 Barmelweid. Switzerland.
Zoya
Z
Marinova
National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. United States.
De-Maw
DM
Chuang
Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Welwyn Garden City, AL8 6HG. United Kingdom.
Naomi
N
Fineberg
D002986:Clinical Trials as Topic; D018683:Excitatory Amino Acid Agents / Q000627:therapeutic use*; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000378:metabolism; D011619:Psychotropic Drugs / Q000494:pharmacology / Q000627:therapeutic use*
D018683:Excitatory Amino Acid Agents; D011619:Psychotropic Drugs
Obsessive-compulsive disorder; clinical
subtypes.; glutamate; glutamate-modulating drugs; memantine; treatment response