Vladimir Coric

Dysfunction of glutamatergic neurotransmission has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD) and recent clinical reports suggest that some glutamate modulating agents are efficacious in the treatment of this disorder. N-acetylcysteine (NAC) is a readily available amino acid compound that is thought to attenuate glutamatergic neurotransmission. NAC may be useful in treating psychiatric disorders involving glutamatergic dysfunction such as OCD. To examine the efficacy of augmentation with NAC in a patient with serotonin reuptake inhibitor (SRI)-refractory OCD. A patient with SRI-refractory OCD was treated with an off-label use of NAC augmentation of fluvoxamine over several weeks. NAC augmentation of fluvoxamine resulted in a marked decrease in Yale-Brown Obsessive Compulsive Scale (Y-BBOCS) score and a clinically significant improvement in OCD symptoms. NAC augmentation was effective in treating SRI-refractory OCD in this single case. Further research is warranted to investigate the use of NAC and other glutamate modulating agents in the treatment of OCD.

Obsessive compulsive disorder (OCD) was once thought to be extremely rare, but recent epidemiological studies have shown it to be the fourth most common psychiatric disorder (after substance abuse, specific phobias, and major depression). OCD is often a chronic disorder that produces significant morbidity when not properly diagnosed and treated. The mainstay of treatment includes cognitive behavioral therapy and medication management. The use of clomipramine in the 1960s and then the introduction of serotonin reuptake inhibitors in the 1980s represented important advances in the pharmacologic treatment of OCD. Despite effective treatment modalities, many patients demonstrate only a partial response or are resistant to available medications. SRI-resistant OCD is one of the few diagnoses in modern psychiatry for which invasive neurosurgical procedures remain part of the established treatment armamentarium. We review current treatment strategies used in the management of OCD symptoms.