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

Hadi, Fatemeh; Kashefinejad, Shayan; Kamalzadeh, Leila; Hoobehfekr, Saba; Shalbafan, Mohammadreza

doi:10.1186/s40360-021-00534-6

Cited by 23 publications

(23 citation statements)

References 51 publications

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“…DSPD and abnormal circadian rhythms affect mood, physical and mental well-being, leading to poor daily-life performance. Moreover, sleep disturbance increases the risk of developing MDD and schizophrenia, and late-life suicide [11,42,43]. Therefore, improving the sleep quality of patients with OCD not only improves their life quality but also helps prevent the worsening of their condition.…”

Section: Discussionmentioning

confidence: 99%

Agomelatine augmentation of sertraline in the treatment of moderate to severe obsessive-compulsive disorder: a randomized double-blinded placebo-controlled clinical trial

Shokrani

Eissazade

Shariat

et al. 2023

Preprint

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Background: As 40-60% of the patients with obsessive-compulsive disorder (OCD) do not adequately respond to the first-line treatment, finding an effective second-line treatment is required. Our aim was to assess the efficacy and safety of agomelatine (a selective melatonin receptor agonist and a 5-hydroxytryptamine (HT)2C antagonist) augmentation of sertraline in the treatment of patients with moderate to severe OCD. Methods: In this 12-week randomized, double-blinded, placebo-controlled, parallel-group clinical trial, 65 patients with moderate to severe OCD according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM–5) criteria and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of over 21, were included. They were assigned with sertraline (100 mg/day for the first 4 weeks and 200 mg/day for the next 8 weeks) and either agomelatine (25 mg/day) or placebo. The primary outcome was OCD symptoms measured by the Y-BOCS. Results: Fifty patients (24 in agomelatine group and 26 in placebo group) completed the trial. The Y-BOCS scores in total (MD (95% CI) = 12.25 (11.00, 13.49) (p-value < 0.0001) vs. MD (95% CI) = 12.46 (6.65, 15.74) (p-value < 0.0001)), the obsession subscale (MD (95% CI) = 5.04 (4.19, 5.88) (p-value < 0.0001) vs. MD (95% CI) = 5.00 (3.84, 6.16) (p-value=0.0001)), and compulsion subscale (MD (95% CI) = 7.21 (6.34, 8.07) (p-value < 0.0001) vs. MD (95% CI) = 7.460 (6.50, 8.42) (p-value < 0.0001)) significantly decreased in both groups. Although, at the end of the trial, no significant difference was observed between the scores of the two groups in total (MD (95% CI) = 0.480 (-1.23, 2.19) (p-value= 0.78)), the obsession subscale (MD (95% CI) = 1.020 (-0.15, 2.19) (p-value=0.38)), and the compulsion subscale (MD (95% CI) = 0.540 (-0.34, 1.42) (p-value=0.54)). No major adverse effects were recorded, and the frequency of side effects was not significantly different between the groups. Conclusion:Agomelatine in augmentation with sertraline is safe and tolerable in patients with moderate to severe OCD. However, our study does not support its efficacy in improving OCD symptoms, compared to placebo. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials on 14/07/2020 (www.irct.ir; IRCT ID: IRCT20170123032145N5). Funding: The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Iran University of Medical Sciences (Grant no: 98-4-75-16914).

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Section: Discussionmentioning

confidence: 99%

Agomelatine augmentation of sertraline in the treatment of moderate to severe obsessive-compulsive disorder: a randomized double-blinded placebo-controlled clinical trial

Shokrani

Eissazade

Shariat

et al. 2023

Preprint

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“…On the other hand, 5HT 3 antagonists modulate the glutamatergic system through N-methyl d-aspartate (NMDA) receptor antagonism. Recently, augmentation strategies using glutamatergic agents has been explored, with promising results, in patients with OCD [11,28,41].…”

Section: Discussionmentioning

confidence: 99%

Granisetron-mediated augmentation of sertraline therapeutic effect in obsessive-compulsive disorder: a double-blind placebo-controlled, randomized clinical trial

Ghobadian

Mokhtari

Shariati

et al. 2022

BMC Pharmacol Toxicol

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Background Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually relieve the severity of symptoms by as much as 20–30%, and satisfactory treatment is obtained in 40–60% of patients with OCD. Nevertheless, the remaining symptoms continue to impair the patients’ function. Therefore, it is necessary to investigate possible strategies to improve the mitigation of symptoms. In this study, the main objective was to examine and investigate the effectiveness of granisetron, which is a serotonin 5-hydroxytryptamine receptor type 3 (5-HT3) antagonist, as an adjunct therapy to selective serotonin reuptake inhibitors, for the purpose of ameliorating OCD symptoms. Methods fifty-eight patients diagnosed with OCD, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, who had a Yale-Brown obsessive-compulsive scale (Y-BOCS) score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either granisetron (1 mg twice daily) and sertraline (100 mg daily initially followed by 200 mg daily after week 4) or placebo and sertraline. The primary outcome was OCD symptoms measured by the Y-BOCS. Results Y-BOCS total score significantly dropped in both groups (28.9 to 17.7 for granisetron plus sertraline and 27.5 to 19.3 for placebo plus sertraline group with a slightly greater drop for granisetron plus sertraline group), while the granisetron plus sertraline group experienced a significantly greater reduction in obsession scores (Greenhouse-Geisser F(2.32,97.57) = 4.52,p-value = 0.01). Moreover, in comparison with the placebo plus sertraline group, the proportion of the patients showing complete response was considerably higher among the granisetron plus sertraline group (P-value < 0.01). No major adverse effects were observed in any of the groups. Conclusion The results suggest that granisetron augmentation of sertraline may increase the rate of response in patients with moderate to severe non-refractory OCD. Further studies are suggested in this regard.

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“…This has also been shown in several other systematic reviews exploring schizophrenia and psychotic disorders, specifically [ 7 , 8 , 9 , 10 , 11 , 12 ]. Finally, a systematic review reported limited support for the use of adjunctive minocycline treatment for obsessive-compulsive disorder [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Minocycline as Treatment for Psychiatric and Neurological Conditions: A Systematic Review and Meta-Analysis

Panizzutti

Skvarc

Lin

et al. 2023

IJMS

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Minocycline has anti-inflammatory, antioxidant, and anti-apoptotic properties that explain the renewed interest in its use as an adjunctive treatment for psychiatric and neurological conditions. Following the completion of several new clinical trials using minocycline, we proposed an up-to-date systematic review and meta-analysis of the data available. The PICO (patient/population, intervention, comparison and outcomes) framework was used to search 5 databases aiming to identify randomized controlled trials that used minocycline as an adjunctive treatment for psychiatric and neurological conditions. Search results, data extraction, and risk of bias were performed by two independent authors for each publication. Quantitative meta-analysis was performed using RevMan software. Literature search and review resulted in 32 studies being included in this review: 10 in schizophrenia, 3 studies in depression, and 7 in stroke, with the benefit of minocycline being used in some of the core symptoms evaluated; 2 in bipolar disorder and 2 in substance use, without demonstrating a benefit for using minocycline; 1 in obsessive-compulsive disorder, 2 in brain and spinal injuries, 2 in amyotrophic lateral sclerosis, 1 in Alzheimer’s disease, 1 in multiple systems atrophy, and 1 in pain, with mixes results. For most of the conditions included in this review the data is still limited and difficult to interpret, warranting more well-designed and powered studies. On the other hand, the studies available for schizophrenia seem to suggest an overall benefit favoring the use of minocycline as an adjunctive treatment.

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

Cited by 23 publications

References 51 publications

Agomelatine augmentation of sertraline in the treatment of moderate to severe obsessive-compulsive disorder: a randomized double-blinded placebo-controlled clinical trial

Agomelatine augmentation of sertraline in the treatment of moderate to severe obsessive-compulsive disorder: a randomized double-blinded placebo-controlled clinical trial

Granisetron-mediated augmentation of sertraline therapeutic effect in obsessive-compulsive disorder: a double-blind placebo-controlled, randomized clinical trial

Minocycline as Treatment for Psychiatric and Neurological Conditions: A Systematic Review and Meta-Analysis

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