Topiramate Augmentation in Resistant OCD: A Double-Blind Placebo-Controlled Clinical Trial

AbstractObjectivesGlutaminergic dysfunction has been shown to be related to the pathphysiology of obsessive-compulsive disorder (OCD). Topiramate is an antiepileptic that inhibits glutaminergic action. The aim of this study is to evaluate the efficacy of topiramate augmentation in patients with treatment resistant OCD.MethodsThis augmentation trial was designed as a 12-week randomized, placebocontrolled, double-blind study. Forty-nine patients suffering from OCD who had failed to respond to at least 12 weeks of treatment of an adequate and stable dose of a selective serotonin reuptake inhibitor (SSRI) were randomly allocated to receive topiramate or placebo plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Treatment response was defined as 25 % or more decrease in scores of Y-BOCS. The mean dosage of topiramate was 180.15 mg/day (range 100–200 mg/day).ResultsForty-one patients (20 of 24 in topiramate group; 21 of 25 in placebo group) completed the trial. The topiramate group showed significant improvement over the study period (mean Y-BOCS score at week 12 as compared with baseline: P=.000). Those receiving topiramate experienced a mean decrease of 32.0% in Y-BOCS score, compared with 2.4% decrease for those receiving placebo. Twelve patients in the topiramate group versus no patient in the placebo group were rated as responder.ConclusionThe results of our study demonstrated that topiramate may augment the therapeutic effect of SSRIs in treatment-resistant OCD patients. However, it should be noted that our study is preliminary and larger double-blind studies are needed to confirm these results.

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Duloxetine augmentation in resistant obsessive compulsive disorder: Surveying a new medication for challenges in treatment of OCD

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.361 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S415-S415

Author(s):

A. Mowla

Keyword(s):

Obsessive Compulsive Disorder ◽

Primary Outcome Measure ◽

Controlled Clinical Trial ◽

Double Blind Study ◽

Obsessive Compulsive ◽

Double Blind ◽

Compulsive Disorder ◽

Significant Difference ◽

Competing Interest ◽

To Receive

IntroductionUp to 50% of patients with OCD have failed to respond in SSRI trials, so looking for pharmacological alternatives in treatment of obsessive compulsive disorder (OCD) seems necessary.ObjectivesSurveying duloxetine augmentation in treatment of resistant OCD.AimsStudy the effects of serotonin-norepinephrine enhancers for treatment of OCD.MethodsThis augmentation trial was designed as an 8-week randomized controlled, double blind study. Forty-six patients suffering from OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure.ResultsForty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement over the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 and P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS.ConclusionsOur double blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in resistant OCD patients. However, it needs to be noted that our study is preliminary and larger double blind placebo controlled studies are necessary to confirm the results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Effect of selenium as an adjunctive therapy in patients with treatment-resistant obsessive-compulsive disorder: A pilot randomized double blind placebo-controlled clinical trial

Archives of Psychiatry and Psychotherapy ◽

10.12740/app/99584 ◽

2018 ◽

Vol 20 (4) ◽

pp. 57-65 ◽

Cited By ~ 1

Author(s):

mehdi Sayyah ◽

Mina Andishmand ◽

Reza Ganji

Keyword(s):

Clinical Trial ◽

Obsessive Compulsive Disorder ◽

Adjunctive Therapy ◽

Controlled Clinical Trial ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Double Blind ◽

Double Blind Placebo ◽

Compulsive Disorder

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Double-Blind Study of Dextroamphetamine Versus Caffeine Augmentation for Treatment-Resistant Obsessive-Compulsive Disorder

The Journal of Clinical Psychiatry ◽

10.4088/jcp.08m04605 ◽

2009 ◽

Vol 70 (11) ◽

pp. 1530-1535 ◽

Cited By ~ 37

Author(s):

Lorrin M. Koran ◽

Elias Aboujaoude ◽

Nona N. Gamel

Keyword(s):

Obsessive Compulsive Disorder ◽

Blind Study ◽

Double Blind Study ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Double Blind ◽

Compulsive Disorder

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Pregabalin augmentation for resistant obsessive–compulsive disorder: a double-blind placebo-controlled clinical trial

CNS Spectrums ◽

10.1017/s1092852919001500 ◽

2019 ◽

Vol 25 (4) ◽

pp. 552-556

Author(s):

Arash Mowla ◽

Mehrnoosh Ghaedsharaf

Keyword(s):

Clinical Trial ◽

Placebo Group ◽

Obsessive Compulsive Disorder ◽

Controlled Clinical Trial ◽

Obsessive Compulsive ◽

Double Blind ◽

Good Tolerability ◽

Double Blind Placebo ◽

Compulsive Disorder ◽

Current Medication

AbstractBackground and objective.Glutamate dysfunction has been shown to be associated with pathophysiology of obsessive–compulsive disorder (OCD). Our objective is to survey the effects of pregabalin (a glutamate-modulating agent) as an augmenting treatment for resistant OCD.Patients and methods.In this 12-week double-blind placebo-controlled clinical trial, 56 patients with resistant OCD were randomly allocated to receive either pregabalin or placebo plus their current medication (sertraline). Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was used to evaluate the outcomes. Adverse effects were also registered.Results.Of the 56 patients with resistant OCD who were randomly allocated in 2 groups of pregabalin (n = 28) and placebo group (n = 28), 42 patients (22 in pregabalin group and 20 in placebo group) completed the trial. Throughout the trial, the mean score decreased from 26.13± 7.03 to 8.81 ± 3.47 in the pregabalin group (p < 0) and from 26.85 ± 4.34 to 17.63 ± 4.22 in the placebo group (p < 0). At the end of trial, 16 (57.14%) patients in the pregabalin group and 2 (7.14%) patients in the placebo group showed more than 35% decline in YBOCS (p < .01). The pregabalin group showed good tolerability and safety.Conclusions.Our study revealed that pregabalin, as an augmenting medication, is more effective than placebo in the treatment of patients with resistant OCD.

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Granisetron Augmentation of Sertraline in Obsessive-Compulsive Disorder: A Double-Blind Placebo-Controlled, Randomized Clinical Trial

10.21203/rs.3.rs-1135729/v1 ◽

2022 ◽

Author(s):

Ala Ghobadian ◽

Saba Mokhtari ◽

Behnam Shariati ◽

Leila Kamalzadeh ◽

Mohsen Shati ◽

...

Keyword(s):

Clinical Trial ◽

Placebo Group ◽

Obsessive Compulsive Disorder ◽

Selective Serotonin Reuptake Inhibitors ◽

Complete Response ◽

Controlled Clinical Trial ◽

P Value ◽

Obsessive Compulsive ◽

Double Blind ◽

Compulsive Disorder

Abstract 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 and 27.5 to 19.3 for placebo group with a slightly greater drop for granisetron group), while the granisetron 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 group, the proportion of the patients showing complete response was considerably higher among the granisetron 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.Trial registration: The trial was registered at the Iranian Registry of Clinical Trials on 27/03/2019 (www.irct.ir; IRCT ID: IRCT20170123032145N3).

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Faculty Opinions recommendation of Lamotrigine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.715498009.791052959 ◽

2012 ◽

Author(s):

Evelyn Stewart ◽

Annie J Kuan

Keyword(s):

Obsessive Compulsive Disorder ◽

Serotonin Reuptake ◽

Serotonin Reuptake Inhibitors ◽

Controlled Study ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Double Blind ◽

Double Blind Placebo ◽

Compulsive Disorder

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A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder

Translational Psychiatry ◽

10.1038/s41398-021-01307-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Philip E. Mosley ◽

François Windels ◽

John Morris ◽

Terry Coyne ◽

Rodney Marsh ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Adverse Events ◽

Brain Stimulation ◽

Stria Terminalis ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Double Blind ◽

Bed Nucleus ◽

Compulsive Disorder ◽

Deep Brain

AbstractDeep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Following a one-month postoperative recovery phase, participants entered a three-month randomised, double-blind, sham-controlled phase before a twelve-month period of open-label stimulation incorporating a course of cognitive behavioural therapy (CBT). The primary outcome measure was OCD symptoms as rated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the blinded phase, there was a significant benefit of active stimulation over sham (p = 0.025, mean difference 4.9 points). After the open phase, the mean reduction in YBOCS was 16.6 ± 1.9 points (χ2 (11) = 39.8, p = 3.8 × 10−5), with seven participants classified as responders. CBT resulted in an additive YBOCS reduction of 4.8 ± 3.9 points (p = 0.011). There were two serious adverse events related to the DBS device, the most severe of which was an infection during the open phase necessitating device explantation. There were no serious psychiatric adverse events related to stimulation. An analysis of the structural connectivity of each participant’s individualised stimulation field isolated right-hemispheric fibres associated with YBOCS reduction. These included subcortical tracts incorporating the amygdala, hippocampus and stria terminalis, in addition to cortical regions in the ventrolateral and ventromedial prefrontal cortex, parahippocampal, parietal and extrastriate visual cortex. In conclusion, this study provides further evidence supporting the efficacy and tolerability of DBS in the region of the BNST for individuals with otherwise treatment-refractory OCD and identifies a connectivity fingerprint associated with clinical benefit.

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