Riluzole in psychiatry: a systematic review of the literature

Abstract

Background-The glutamate system appears to be an important contributor to the pathophysiology of mood and anxiety disorders. Thus, glutamatergic modulators are reasonable candidate drugs to test in patients with mood and anxiety disorders. Riluzole, a neuroprotective agent with anticonvulsant properties approved for the treatment of amyotrophic lateral sclerosis (ALS) is one such agent.Objective-To assess the potential risks and benefits of riluzole treatment in psychiatric patients.Methods-A PubMed search was performed using the keywords "riluzole", "inhibitor of glutamate release", and "glutamatergic modulator" in order to identify all clinical studies and case reports involving riluzole in psychiatric patients.Results/Conclusion-Riluzole's side effect profile is favorable, and preliminary results regarding riluzole for the treatment of severe mood, anxiety, and impulsive disorders are encouraging.

Depression gets old fast: do stress and depression accelerate cell aging?

“…To the extent this theoretical model is accurate, several potential treatment loci emerge, as indicated numerically in Figure 1: (1) traditional antidepressants have several novel functions apart from increasing intrasynaptic monoamine concentrations: they up-regulate GR function, [172] increase allopregnanolone synthesis (certain SSRIs), [95] increase BDNF levels, [75] and have anti-inflammatory [174,178] and antioxidant [179,180] effects; (2) CRH antagonists; [181] (3) stress reduction, meditation, and other behavioral and lifestyle interventions; [20,182,183] (4) antiglucocorticoids [47,[184][185][186] ; (5) energy supplementation or insulin receptor sensitizers; [187][188][189] (6) glutamate antagonists; [190][191][192][193][194] (7) calcium blockers [195,196] and antioxidants [197] ; (8) DHEA; [96] (9) 3-a-hydroxy-steroid dehydrogenase (3-a-HSD) stimulators (including SSRIs), which increase allopregnanolone synthesis [94,95] ; (10) environmental enrichment, exercise [198][199][200][201] ; (11) BDNF administration via novel routes of administration [202][203][204] ; (12) telomerase activation, [205,…”

12-Week, Placebo-Controlled Trial of Add-on Riluzole in the Treatment of Childhood-Onset Obsessive–Compulsive Disorder

“…Adjunctive riluzole was fairly well tolerated. Asymptomatic elevated transaminases led to discontinuation of riluzole in five subjects, but this was not associated with any sequelae and reversed rapidly to normal upon drug discontinuation (as previously described in adults, Zarate and Manji, 2008). For these subjects with treatment-resistant OCD, RIL was not found to be superior to placebo in reducing symptoms of OCD or global functioning, as measured by the primary (CY-BOCS, CGAS, and CGI) and secondary outcomes.…”

“…Riluzole, a glutamatergic modulator, has preliminary data supporting its effectiveness in several adult psychiatric disorders (Zarate and Manji, 2008). Following a successful open-label trial (Grant et al, 2007), we hypothesized that riluzole would be effective for treatment of OCD in children.…”

“…Currently, the only FDA indication for riluzole is in amyotrophic lateral sclerosis; there are no indications for childhood conditions. Recently, riluzole has been studied in a number of open-label trials for generalized anxiety disorder, major depressive disorder, bipolar depression, and OCD in adults, as well as in one double-blind trial (see review: Zarate and Manji, 2008). These reports suggest beneficial effects of riluzole.…”

“…These reports suggest beneficial effects of riluzole. Riluzole is generally well tolerated; it is occasionally associated with mild reversible elevations in transaminases (Zarate and Manji, 2008).…”