Riluzole Augmentation in Treatment-refractory Obsessive-compulsive Disorder: a Pilot Randomized Placebo-controlled Trial

Overview

Journal J Clin Psychiatry

Specialty Psychiatry

Date 2015 Jul 28

PMID 26214725

Citations 27

Authors

Christopher Pittenger

Michael H Bloch

Suzanne Wasylink

Eileen Billingslea

Ryan Simpson

Ewgeni Jakubovski

Ben Kelmendi

Gerard Sanacora

Vladimir Coric

Affiliations

Soon will be listed here.

Abstract

Objective: Obsessive-compulsive disorder (OCD) affects approximately 2.5% of the population and is associated with significant morbidity. Many patients receive little benefit from the best available treatments, and even those who do respond often suffer from significant residual symptoms. Convergent evidence suggests that abnormalities in glutamate homeostasis and neurotransmission may contribute to OCD and that glutamate-modulating medications may be of benefit in patients whose symptoms are refractory to standard interventions. Small open-label trials of augmentation of serotonin reuptake inhibitor (SRI) pharmacotherapy with the glutamate modulator riluzole have suggested benefit in adults with refractory symptoms. We report a pilot randomized placebo-controlled trial of riluzole augmentation of ongoing SRI treatment in SRI-refractory patients.

Method: Outpatients (n = 27) and inpatients (n = 11) with DSM-IV OCD on stable SRI pharmacotherapy were randomized between November 2006 and December 2012 to receive riluzole 50 mg or placebo twice a day and followed for 12 weeks after a 2-week placebo lead-in phase.

Results: Riluzole was well tolerated; 1 patient experienced moderate nausea, but none discontinued treatment due to side effects. While there was nominally greater Y-BOCS improvement in the riluzole group (our primary outcome) compared to placebo, it did not reach statistical significance. In the outpatient subsample, a trend suggesting benefit from riluzole augmentation for obsessions (P = .056, 2-tailed, uncorrected) was found in a secondary analysis. Among outpatients, more achieved at least a partial response (> 25% improvement) with riluzole than with placebo (P = .02 in a secondary analysis).

Conclusions: Riluzole may be of benefit to a subset of patients. Larger samples would be required to detect effects of the order suggested by the nominal improvement in our outpatient subsample.

Trial Registration: ClinicalTrials.gov identifier: NCT00523718.

Citing Articles

Glutamatergic Medications for Obsessive-Compulsive and Related Disorders: A Systematic Review and Meta-Analysis.

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Ceftriaxone Inhibits Conditioned Fear and Compulsive-like Repetitive Marble Digging without Central Nervous System Side Effects Typical of Diazepam-A Study on DBA2/J Mice and a High-5HT Subline of Wistar-Zagreb 5HT Rats.

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Effects of riluzole on psychiatric disorders with anxiety or fear as primary symptoms: A systematic review.

Kawashima Y, Yamada M, Furuie H, Kuniishi H, Akagi K, Kawashima T Neuropsychopharmacol Rep. 2023; 43(3):320-327.

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Memantine augmentation of sertraline in the treatment of symptoms and executive function among patients with obsessive-compulsive disorder: A double-blind placebo-controlled, randomized clinical trial.

Askari S, Mokhtari S, Shariat S, Shariati B, Yarahmadi M, Shalbafan M BMC Psychiatry. 2022; 22(1):34.

PMID: 35022014 PMC: 8753835. DOI: 10.1186/s12888-021-03642-z.

Glutamatergic medications as adjunctive therapy for moderate to severe obsessive-compulsive disorder in adults: a systematic review and meta-analysis.

Hadi F, Kashefinejad S, Kamalzadeh L, Hoobehfekr S, Shalbafan M BMC Pharmacol Toxicol. 2021; 22(1):69.

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