Lithium: a potential therapeutic strategy in obsessive–compulsive disorder by targeting the canonical WNT/β pathway

AbstractObsessive–compulsive disorder (OCD) is a neuropsychiatric disorder characterized b–y recurrent and distinctive obsessions and/or compulsions. The etiologies remain unclear. Recent findings have shown that oxidative stress, inflammation, and the glutamatergic pathway play key roles in the causes of OCD. However, first-line therapies include cognitive–behavioral therapy but only 40% of the patients respond to this first-line therapy. Research for a new treatment is mandatory. This review focuses on the potential effects of lithium, as a potential therapeutic strategy, on OCD and some of the presumed mechanisms by which lithium provides its benefit properties. Lithium medication downregulates GSK-3β, the main inhibitor of the WNT/β-catenin pathway. The activation of the WNT/β-catenin could be associated with the control of oxidative stress, inflammation, and glutamatergic pathway. Future prospective clinical trials could focus on lithium and its different and multiple interactions in OCD.

Download Full-text

Treatments for Obsessive-Compulsive Disorder

10.1093/med:psych/9780199342211.003.0017 ◽

2015 ◽

Cited By ~ 2

Author(s):

Darin D. Dougherty ◽

Scott L. Rauch ◽

Michael A. Jenike

Keyword(s):

Obsessive Compulsive Disorder ◽

Behavior Therapy ◽

First Line ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

First Line Therapy ◽

Line Therapy ◽

Augmentation Strategies ◽

Overwhelming Evidence ◽

Limited Support

There is overwhelming evidence of the most rigorous type supporting the efficacy of serotonin reuptake inhibitors (SRIs) in the treatment of obsessive-compulsive disorder (OCD). Along with SRIs, behavior therapy must be considered a viable first-line therapy. The best available data suggest that behavior therapy, and perhaps cognitive therapy, is at least as effective as medication in some instances and may be superior with respect to risks, costs, and enduring benefits. A variety of second-line medication treatments for OCD have been studied in a controlled or systematic fashion. Augmentation of SRIs with antipsychotics, buspirone, or clonazepam is provisionally recommended based on the available data. Other monotherapies and augmentation strategies find very limited support at present.

Download Full-text

Selecting a Serotonin Reuptake Inhibitor for Obsessive-Compulsive Disorder

CNS Spectrums ◽

10.1017/s1092852900002625 ◽

1996 ◽

Vol 1 (2) ◽

pp. 32-38 ◽

Cited By ~ 2

Author(s):

Alison Kelly

Keyword(s):

Obsessive Compulsive Disorder ◽

Common Condition ◽

First Line ◽

Obsessive Compulsive ◽

Double Blind ◽

Compulsive Disorder ◽

Treatment Comparison ◽

First Line Therapy ◽

Line Therapy ◽

High Doses

AbstractAlthough considered rare and intractable until relatively recently, obsessive-compulsive disorder (OCD) is now recognized as a common condition that can be treated. Clomipramine initially dominated the treatment of OCD, but the introduction of the selective serotonin reup-take inhibitors (SSRIs) now allows OCD to be treated without the unpleasant adverse effects associated with the high doses of clomipramine necessary in OCD. Double-blind, placebo-controlled, and active treatment comparison trials showing the efficacy of fluvoxamine and fluoxetine in particular now provide good reasons to consider SSRIs as first-line therapy for OCD.

Download Full-text

Anxiety, Obsessive-Compulsive, and Stress Disorders

10.1093/med/9780199326075.003.0006 ◽

2014 ◽

Author(s):

Franklin R. Schneier ◽

Hilary B. Vidair ◽

Leslie R. Vogel ◽

Philip R. Muskin

Keyword(s):

Anxiety Disorder ◽

Obsessive Compulsive Disorder ◽

Selective Serotonin Reuptake Inhibitors ◽

Behavioral Therapy ◽

Stress Disorders ◽

Panic Attacks ◽

Social Situations ◽

First Line ◽

Obsessive Compulsive ◽

Compulsive Disorder

Patients with generalized anxiety disorder experience anxiety related to multiple areas, such as work, finances, and illness. Discrete, unexpected panic attacks and anticipatory anxiety characterize patients with panic disorder. Patients with social anxiety disorder have fear of embarrassment in social situations. Patients with obsessive-compulsive disorder are preoccupied with and distressed by inappropriate thoughts, urges, and images. The four cardinal features of posttraumatic stress disorder are intrusive reexperiencing of the initial trauma, avoidance, persistent negative alterations in cognitions and mood, and alterations in arousal and activity. One element common to patients suffering from most of the anxiety disorders is an elevated sensitivity to threat, which appears to involve brain systems identified to mediate “fear” responses, including the amygdala. The selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the first-line pharmacotherapy treatment for obsessive-compulsive disorder and most of the anxiety and stress disorders. Cognitive-behavioral therapy for anxiety, obsessive-compulsive, and stress disorders is an empirically validated time-limited treatment.

Download Full-text

The Medical Treatment of Obsessive-Compulsive Disorder and Anxiety

CNS Spectrums ◽

10.1017/s1092852900026924 ◽

2008 ◽

Vol 13 (S14) ◽

pp. 37-46 ◽

Cited By ~ 23

Author(s):

Borwin Bandelow

Keyword(s):

Anxiety Disorders ◽

Obsessive Compulsive Disorder ◽

Selective Serotonin Reuptake Inhibitors ◽

Behavioral Therapy ◽

Treatment Options ◽

First Line ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

History Of ◽

Higher Doses

AbstractSelective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy treatments for obsessive-compulsive disorder (OCD). Clomipramine is effective in OCD but associated with more adverse events. Typically, higher doses of antidepressants are required for OCD. Up to 50% of patients do not respond to initial treatment of OCD. Treatment options for nonresponders include augmentation of antidepressants with atypical antipsychotics, among other strategies. First-line treatments for anxiety disorders include SSRIs, serotonin norepinephrine reuptake inhibitors, and pregabalin. Tricyclic antidepressants are equally effective as SSRIs, but are less well tolerated. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of dependency and tolerance. Other treatment options include irreversible and reversible monoamine oxidase inhibitors, the atypical antipsychotic quetiapine, and other medications. Cognitive-behavioral therapy has been sufficiently investigated in controlled studies of OCD and anxiety disorders and is recommended alone or in combination with the above medications.

Download Full-text

Obsessive-Compulsive Disorder: Diagnosis and Management with an Osteopathic Component

Osteopathic Family Physician ◽

10.33181/12062 ◽

2020 ◽

pp. 18-24

Author(s):

Theodore Flaum ◽

Ravi Chinsky ◽

Sheldon Yao

Keyword(s):

Obsessive Compulsive Disorder ◽

Behavioral Therapy ◽

Physical And Mental Health ◽

Obsessive Compulsive ◽

Holistic View ◽

Compulsive Disorder ◽

Dsm 5 ◽

First Line Therapy ◽

Synergistic Approach ◽

American Children

Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that affects about one in 40 American adults and one in 100 American children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the patient must have the presence of obsessions, compulsions or both. OCD can be covert in presentation and therefore requires physician vigilance with the diagnosis. The efficacy of the physician’s interviewing style is extremely important in OCD treatment because typically, long delays in diagnosis often occur and the shame associated with the disorder may inhibit discussion of the symptoms and treatment plans. In addition to serotonin-regulating medications, deciphering the etiology of the patient’s obsessions or compulsions is important. Thus, cognitive behavioral therapy supplemented with SSRIs is the true first-line therapy for OCD because it provides a synergistic approach of life discussions, habit training and medication. Because of the inseparability of physical and mental health, osteopathic medicine offers an effective model for treatment through osteopathic manipulative treatment (OMT). In the holistic view of OMT, somatic, visceral and psychological dysfunctions are united. Thus, physicians who incorporate OMT into their practice can aid in the treatment of psychopathology, such as OCD. In this article, we will discuss the epidemiology of OCD, the DSM-5 criteria for OCD, the current OCD treatments, the osteopathic approach and how it pertains to OCD treatment, and lastly, OMT and its possible role in treating OCD. Due to a lack of research on osteopathic manipulative medicine (OMM) treatments in OCD, we will also propose a possible study design for further investigation.

Download Full-text