Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Psychiatry, University of Social Welfare and Rehabilitation, Tehran, Iran.
BMC Psychiatry. 2022 Jan 12;22(1):34. doi: 10.1186/s12888-021-03642-z.
Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually decrease the severity of the symptoms by 20-30%; however, 40-60% of OCD patients do not achieve a satisfactory response. Our main objective was to investigate the effectiveness of memantine, a non-competitive N-Methyl-D-aspartate (NMDA) receptor antagonist, as an adjunct therapy to sertraline, a selective serotonin reuptake inhibitor (SSRI), to improve severity of symptoms and executive function among patients with obsessive-compulsive disorder.
Seventy patients with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of more than 21 were recruited to the study. They received sertraline (100 mg daily initially followed by 200 mg daily after week 4) and either memantine (10 mg twice daily) or placebo in a placebo controlled, double-blinded, parallel-group, clinical trial of 12 weeks. The primary outcome was OCD symptoms measured by the Y-BOCS. Moreover, executive function of participants was measured by the Wisconsin Card Sorting Test (WCST).
The total score, and obsession and compulsion subscales of Y-BOCS significantly dropped in both groups with no significant difference between the two groups. However, memantine group showed a greater response in the number of completed categories subscale of the WCST (p value<0.001). We did not observe any major adverse effects in any of the groups.
Memantine has an acceptable safety and tolerability in patients with OCD and might have a positive effect on their executive function. Nevertheless, the current results don`t support the efficacy of memantine as an adjunctive agent to sertraline for symptoms in patients with OCD.
The trial was registered at the Iranian Registry of Clinical Trials on 04/10/2019 ( www.irct.ir ; IRCT ID: IRCT20170123032145N4).
目前推荐用于治疗强迫症（OCD）的药物通常可使症状严重程度降低 20-30%；然而，40-60%的 OCD 患者未获得满意的疗效。我们的主要目的是研究作为一种辅助疗法，非竞争性 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂美金刚与选择性 5-羟色胺再摄取抑制剂（SSRI）舍曲林联合治疗强迫症患者，对改善其症状严重程度和执行功能的疗效。
本研究共纳入 70 名符合《精神障碍诊断与统计手册》（DSM-5）标准的 OCD 患者和耶鲁-布朗强迫量表（Y-BOCS）评分>21 分的患者。他们接受舍曲林（初始剂量 100mg/天，第 4 周后增加至 200mg/天）和美金刚（10mg/天，每日两次）或安慰剂治疗，为期 12 周的安慰剂对照、双盲、平行组临床试验。主要结局是用 Y-BOCS 评估 OCD 症状。此外，还通过威斯康星卡片分类测验（WCST）评估参与者的执行功能。
两组的 Y-BOCS 总分、强迫观念和强迫行为分量表均显著下降，两组间无显著差异。然而，美金刚组在 WCST 完成分类数子量表上的反应更大（p 值<0.001）。两组均未观察到任何严重不良事件。
美金刚在 OCD 患者中具有可接受的安全性和耐受性，并且可能对其执行功能产生积极影响。然而，目前的结果并不支持美金刚作为辅助药物与舍曲林联合治疗 OCD 患者的疗效。
该试验于 2019 年 10 月 4 日在伊朗临床试验注册中心注册（www.irct.ir；IRCT 编号：IRCT20170123032145N4）。
