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Obsessive compulsive disorder and the glutamatergic system

Kariuki-Nyuthe, Catherinea; Gomez-Mancilla, Baltazarb; Stein, Dan J.c

Current Opinion in Psychiatry: January 2014 - Volume 27 - Issue 1 - p 32–37
doi: 10.1097/YCO.0000000000000017
MOOD AND ANXIETY DISORDERS: Edited by Cornelius Katona and Gordon Parker

Purpose of review: Evidence-based pharmacological interventions for obsessive compulsive disorder (OCD) are targeted mainly at the serotonergic and dopaminergic pathways, and are not always effective. It is timely to review the growing evidence from animal models and clinical research (e.g., brain imaging, genetics) on the role of the glutamatergic system in OCD.

Recent findings: Emerging evidence from both animal models and clinical research (including brain imaging, neurogenetics) supports the glutamatergic system as a potential target for pharmacotherapy in OCD. Although there have been relatively few randomized controlled trials of glutamatergic agents in pediatric or adult OCD to date, there is some work on riluzole, memantine, ketamine, topiramate, lamotrigine, N-acetylcysteine, and D-cycloserine.

Summary: Given the need for more efficacious treatments in OCD, and given emergent findings on the role of the glutamatergic system in this disorder, there is a need for additional pharmacotherapy trials on glutamatergic agents in OCD. Possible research designs for such trials might include stand-alone approaches, pharmacotherapy augmentation, or psychotherapy augmentation.

aEastern Health, Maroondah Hospital Adult Mental Health Services, Melbourne, Victoria, Australia

bNovartis Institutes for Biomedical Research, Translational Medicine Neuroscience, Basel, Switzerland

cDepartment of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa

Correspondence to Catherine Kariuki-Nyuthe, Eastern Health, Maroondah Hospital Adult Mental Health Services, 4 Bona Street, Ringwood East, 3135, Melbourne, Victoria, Australia. Tel: +61 431050225; fax: +61 398711730; e-mail: drkariuki@yahoo.com

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins