Department of Psychosomatic Medicine, Clinic Barmelweid, 5017 Barmelweid. Switzerland.
National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. United States.
Curr Neuropharmacol. 2017;15(7):977-995. doi: 10.2174/1570159X15666170320104237.
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.
We conducted a search of the MEDLINE database for clinical studies evaluating the effect of glutamate-modulating drugs in OCD.
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.
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.
强迫症（OCD）是一种常见的精神疾病，常伴有严重的痛苦和社交功能障碍。选择性 5-羟色胺再摄取抑制剂和/或认知行为疗法是首选的治疗方法，但多达 40%的患者对治疗没有反应。谷氨酸能信号也与 OCD 有关。本研究旨在回顾谷氨酸调节药物作为 OCD 患者的增效治疗或单药治疗的临床证据。
我们在 MEDLINE 数据库中搜索了评估谷氨酸调节药物在 OCD 中疗效的临床研究。
美金刚是作为增效治疗在 OCD 中最一致显示出积极效果的化合物。抗惊厥药物（拉莫三嗪、托吡酯）和利鲁唑也可能对一些 OCD 患者有治疗益处。最后，由于其可能具有快速作用的特点，氯胺酮可能具有研究意义。
需要在更大的研究人群中进行随机安慰剂对照试验，以得出关于谷氨酸调节药物在 OCD 中的效用的明确结论。此外，需要系统地研究遗传和表观遗传因素、预测谷氨酸调节药物治疗反应的临床症状和亚型。
