Glutamatergic Meds Show Promise for OCD Disorders

TOPLINE:

Glutamatergic drugs are associated with a significant improvement in symptoms of obsessive-compulsive and related disorders (OCRDs) compared with control treatments, a new review and meta-analysis suggests.

METHODOLOGY:

• Researchers evaluated symptom improvement in OCRD associated with glutamatergic medications, as monotherapy or augmentation to selective serotonin reuptake inhibitors,
• Overall, 27 double-blind, placebo-controlled randomized clinical trials were assessed.
• More than 1300 participants (mean age, 31.5 years; 66% women) were included in the analysis.
• Subgroup analyses included population, refractoriness, augmentation strategy, risk for bias, and type of glutamatergic medication.

TAKEAWAY:

• Groups taking glutamatergic medications showed a large effect size in improving OCRD symptoms compared with control groups (Cohen d, −0.8; P
• In trials that focused on just obsessive-compulsive disorder (OCD), glutamatergic medications showed a significant mean reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores vs control treatments (mean difference, −4.17; P
• There were no significant differences in any of the subgroup analyses.
• Researchers noted high heterogeneity and potential publication bias in the overall analysis.

IN PRACTICE:

“Our findings, albeit with low certainty, indicate that these medications are associated with significant improvement in OCRD symptoms,” the investigators wrote. They added that the certainty went up to moderate for reduced Y-BOCS scores when restricting to OCD-only trials.

SOURCE:

The study was led by David R. A. Coelho, MD, Harvard T.H. Chan School of Public Health, Boston. It was published online on January 2 in JAMA Network Open.

LIMITATIONS:

The study was limited by relatively small sample sizes in the trials and a limited number of studies for some subgroups, particularly those testing lamotrigine and topiramate. Non-English studies and gray literature were excluded from the analysis. Researchers were unable to assess dose-dependent effects due to dose escalation and inconsistent reporting across studies. Studies for OCRDs, such as body dysmorphic disorder and hoarding disorder, were not included. Additionally, promising therapeutic glutamatergic medications, such as ketamine and troriluzole, did not meet the inclusion criteria.

DISCLOSURES:

The study was funded by the Center for Obsessive-Compulsive and Related Disorders at Massachusetts General Hospital. One investigator reported receiving support from the Jorge Paulo Lemann Fellowship, while another reported receiving grants from the São Paulo Research Foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.