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Glutamatergic medications as adjunctive therapy for moderate to severe obsessive-compulsive disorder in adults: a systematic review and meta-analysis.

  • 2021-11-04
  • BMC pharmacology & toxicology 22(1)
    • Fatemeh Hadi
    • Shayan Kashefinejad
    • Leila Kamalzadeh
    • Saba Hoobehfekr
    • Mohammadreza Shalbafan

Study Design

Type
Meta-Analysis
Sample size
n = 759
Population
patients with OCD (obsessive-compulsive disorder)
Methods
systematic review and meta-analysis of 17 studies with 759 patients; searched Medline, Scopus, Cochrane library; glutamatergic medications plus SSRIs vs SSRI+placebo

Background

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, 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.

Method

We 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.

Results

We 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).

Conclusion

Augmentation of glutamatergic medications with SSRIs are beneficial in obsessive-compulsive patients, no harmful significant differences in any safety outcome were found between the groups.

Research Insights

  • L-Carnosine→Reduced Obsessive-Compulsive Symptoms

    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).

    Effect
    Beneficial
    Effect size
    Large
  • N-Acetyl Cysteine→Reduced Obsessive-Compulsive Symptoms

    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).

    Effect
    Beneficial
    Effect size
    Large
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