High-Dose Glycine Treatment of Refractory Obsessive-Compulsive Disorder and Body Dysmorphic Disorder in a 5-Year Period

W Louis Cleveland,Roger S Challop,Robert L Delapaz,Rashid A Fawwaz

doi:10.1155/2009/768398

Abstract

This paper describes an individual who was diagnosed with obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) at age 17 when education was discontinued. By age 19, he was housebound without social contacts except for parents. Adequate trials of three selective serotonin reuptake inhibitors, two with atypical neuroleptics, were ineffective. Major exacerbations following ear infections involving Group A β-hemolytic streptococcus at ages 19 and 20 led to intravenous immune globulin therapy, which was also ineffective. At age 22, another severe exacerbation followed antibiotic treatment for H. pylori. This led to a hypothesis that postulates deficient signal transduction by the N-methyl-D-aspartate receptor (NMDAR). Treatment with glycine, an NMDAR coagonist, over 5 years led to robust reduction of OCD/BDD signs and symptoms except for partial relapses during treatment cessation. Education and social life were resumed and evidence suggests improved cognition. Our findings motivate further study of glycine treatment of OCD and BDD.

Highlights

Obsessive Compulsive Disorder (OCD) is an illness that is characterized by recurrent obsessions and compulsions that cause marked distress and impairment [1]
We present the observations from a five-year period in which glycine, an N-methyl-D-aspartate receptor (NMDAR) coagonist, was used as the sole treatment of previously refractory OCD and body dysmorphic disorder (BDD)
Do the Results of This Case Study Support the HypoNMDAR-ST Hypothesis? The results of this high-dose glycine trial with refractory OCD, BDD, and cognition deficits are in unequivocal agreement with the main prediction of the Hypo-NMDAR-ST hypothesis that inspired its initiation

Summary

Introduction

Obsessive Compulsive Disorder (OCD) is an illness that is characterized by recurrent obsessions and compulsions that cause marked distress and impairment [1]. It has a lifetime prevalence of 2-3% and is the fourth most prevalent psychiatric disorder [2]. Up to 30–40% of patients fail to respond significantly to current treatments and those who do respond often experience only partial remissions [4, 5]. Patients who fail to respond to two serotonin reuptake inhibitors (SSRIs) are considered “refractory” [6]. Given the nature of these treatments, there is an urgent need for effective pharmacotherapy

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Discussion

Conclusion