Abstract
BackgroundObsessive-compulsive disorder (OCD) is among the most disabling neuropsychiatric conditions characterized by the presence of repetitive intrusive thoughts, impulses, or images (obsessions) and/or ritualized mental or physical acts (compulsions). Serotonergic medications, particularly Selective Serotonin Reuptake Inhibitors (SSRIs), are the first-line treatments for patients with OCD. Recently, dysregulation of glutamatergic system has been proposed to be involved in the etiology of OCD. We designed this systematic review and meta-analysis to evaluate clinical efficacy of glutamatergic medications in patients with OCD, according to the guidelines of Cochrane collaboration.MethodWe searched Medline, Scopus, and Cochrane library without applying any language filter. Two of the authors independently reviewed search results for irrelevant and duplicate studies and extracted data and assessed methodological quality of the studies. We transformed data into a common rubric and calculated a weighted treatment effect across studies using Review Manager.ResultsWe found 476 references in 3 databases, and after exclusion of irrelevant and duplicate studies, 17 studies with total number of 759 patients with OCD were included. In the present review we found evidence for several drugs such as memantine, N-acetylcysteine (NAC), Minocycline, L-carnosine and riluzole. Glutamaterigic drug plus SSRIs were superior to SSRI+ Placebo with regard to Y-BOCS scale [standardized mean difference (SMD = − 3.81 95% CI = − 4.4, − 3.23).ConclusionAugmentation of glutamatergic medications with SSRIs are beneficial in obsessive-compulsive patients, no harmful significant differences in any safety outcome were found between the groups.
Highlights
Obsessive-compulsive disorder (OCD) is among the most disabling neuropsychiatric conditions characterized by the presence of repetitive intrusive thoughts, impulses, or images and/or ritualized mental or physical acts [1]
Description of included studies We found 476 studies of interest in the initial electronic searches
Our primary outcome measure was the mean difference in Yale-Brown obsessive-compulsive score (YBOCS) ratings before and after pharmacological intervention in experimental and control groups
Summary
Obsessive-compulsive disorder (OCD) is among the most disabling neuropsychiatric conditions characterized by the presence of repetitive intrusive thoughts, impulses, or images (obsessions) and/or ritualized mental or physical acts (compulsions). Serotonergic medications, Selective Serotonin Reuptake Inhibitors (SSRIs), are the first-line treatments for patients with OCD. OCD affects approximately 1–2% of adult general population worldwide [2]. It is associated with significant functional impairment, both due to the primary illness, as well high comorbidity with other psychiatric disorders. Recommended first-line pharmacotherapies for OCD are serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and clomipramine [5, 6]. Estimates suggest that around 30–60% of patients do not improve or show a partial response to adequate serotonergic antidepressant treatment, implying that serotonergic dysregulation may not be the one but rather one of many important mechanisms that are involved in the pathophysiology of OCD
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