Riluzole Augmentation for Treatment-Resistant Depression

Abstract

TO THE EDITOR: Glutamate is implicated in the pathophysiology and treatment of mood disorders (1). The following case reports pertain to the use of riluzole, a putative antiglutamatergic agent indicated for the treatment of amyotrophic lateral sclerosis, as add-on therapy for treatment-resistant major depressive disorder. Ms. A wasa 42-year-old woman with a history of major depressive disorder. Despite pharmacotherapy strategies, including fluoxetine, fluoxetine augmented with lithium, and her current regimen of bupropion (100 mg b.i.d.) and venlafaxine (up to 300 mg/day), she remained depressed, with scores of 21 on the 25-item Hamilton Depression Rating Scale and 17 on the Beck Depression Inventory. After we obtained written informed consent, riluzole, 50 mg b.i.d., was added to her current medication regimen. Within 1 week, her Hamilton depression scale and Beck Depression Inventory scores decreased by 16 and 10 points, respectively. Repeated measures of her depression severity reflected scores in the remitted range, with a score of 1 on the Hamilton depression scale and 0 on the Beck Depression Inventory at the end of 6 weeks and a Hamilton depression scale score of 4 and a Beck Depression Inventory score of 4 at the end of 12 weeks of continued treatment.

Preliminary Evidence of Riluzole Efficacy in Antidepressant-Treated Patients with Residual Depressive Symptoms

“…Over the six-week trial, subjects received a mean riluzole dose of 95.0 ± 17.1 mg/day. .05] scores remained significant in separate analyses excluding two subjects who were previously described in a case report (Sanacora et al 2004).…”

The immune-mediated alteration of serotonin and glutamate: towards an integrated view of depression

“…14 A recent series of openlabelled studies and case reports demonstrated its efficacy. [15][16][17][18][19] Although the glutamatergic system may influence directly or indirectly the serotonergic and noradrenergic neurotransmission, there are only few data in the literature dealing with this interaction. NMDA receptor antagonists increase the serotonin levels in the brain.…”

Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder

“…Case reports and open label studies suggest efficacy in the treatment of major depression, 11,12,112,113 bipolar depression, 114,115 anxiety, 12 and OCD. 12 Ongoing studies examining the effect on schizophrenia have also begun at our center (Zimolo, Z., Yale University, personal communication).…”