Posted by temoigneur on April 20, 2008, at 2:04:07
In reply to Re: Happy Ending :P - OCD/major depression/psychos, posted by emilio on April 19, 2008, at 6:34:48
Hi Emilio,
Yes, I believe memantine can bring about a dramatic remission of OCD symptoms in a subset of OCD patients. In my case, I developed extreme fatigue, and my OCD became dormant. Whenever I took stimulants to treat the ADHD or 'wake up', the OCD/psychosis, would make a vicious reappearance. Only since starting the memantine, have I not only been able to tolerate stimulants, but take them constantly for my ADHD, and flourish brilliantly on them.I've only come across one abstract that talks about memantine's success in OCD/schizotypal personality disorder, although the account is dramatic, like my own:
Anecdotal account of remission of OCD/schizotypal symptoms correlated with Memantine treatment;
Add-On Memantine for Treatment-Resistant
Obsessive-Compulsive Disorder
The N-methyl-D-aspartic acid (NMDA) receptor appears to be involved in the pathophysiology of several neuropsychiatric disorders, including schizophrenia and obsessive-compulsive disorder (OCD), both of which are believed to be associated with excess production of glutamate in the brain and hyperexcitation of glutamate receptors.1-4
In pediatric OCD patients, abnormally elevated concentrations of glutamate in the caudate have been observed; these levels decrease after treatment with paroxetine.4
While currently available treatments, such as serotonin reuptake inhibitors, and cognitive-behavioral therapy are efficacious treatments of OCD, approximately 40% to 60% of patients experience significant reduction of symptoms, with many others demonstrating either partial or no response.
Consequently, adjunctive treatments such as dopamine antagonists have been utilized in an effort to more effectively treat a wider range of patients. In severe, resistant cases, neurosurgery or deep brain stimulation may even be recommended.
Memantine is an NMDA receptor antagonist approved for moderate-to-severe Alzheimers disease. Now comes a report on the adjunctive use of memantine for treatment-resistant OCD.5
A 34-year-old woman with schizotypal personality disorder presented with incapacitating ego-dystonic obsessions, including fear of harm to her daughter and of losing her mind.
She developed compulsive checking behavior to decrease the associated anxiety. Her history was notable for onset of obsessive-compulsive symptoms at 16 years of age, which remitted spontaneously 2 years later.
Subsequent postpartum exacerbation of OCD symptoms associated with major depression occurred at 30 years of age.
The patient received adequate trials of paroxetine and sertraline; however, these were ineffective. Risperidone was added on, but due to marked akathisia, the drug had to be discontinued.
At the time of presentation, oral clomipramine was initiated and titrated to 300 mg/day. Ten weeks later, there was still no significant clinical improvement, as evidenced by a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of 35.
Addition of the selective dopamine D2 antagonist sulpiride, up to 400 mg/day for 4 weeks, was also ineffective (YBOCS=34). At this point, it was decided to add memantine to the combination regimen of clomipramine 300 mg/day and sulpiride 400 mg/day. Memantine was started at 5 mg/day, then titrated to 20 mg/day within 2 weeks.
Within 7 days, the patient reported initial relief. By day 21, there was a significant decline in symptom severity (YBOCS=22). Clinically, the patient reported a substantial reduction in the time occupied by OCD and distress, followed by increased control over obsessions.
This improvement was maintained over the next 3 months, with no significant side effects.
This appears to be the first published report on the use of memantine as an adjunctive agent for treatment-resistant OCD, in this case in a patient with schizotypal personality disorder. The presence of OCD-schizotypal comorbidity is interesting given the role of glutamatergic dysfunction in both OCD and schizophrenia spectrum disorders.Controlled trials are indicated to more fully evaluate the potential utility of adjunctive memantine in treatment-resistant OCD. PP
source: http://www.primarypsychiatry.com/aspx/articledetai
Currently, studies are being done at Stanford with memantine on OCD patients. Headed by Lorrin Koran, I found the listing of his reportings in this journal, although I haven't had a chance to read it:
Citation from American Journal of Psychiatry for article on memantine for OCD by prominent OCD researcher/psychiatrist, Lorrin Koran, & others..
Am J Psychiatry. 2005 Nov ;162 (11):2191-2 16263867 (P,S,E,B,D) Memantine for Treatment-Resistant OCD.
[My paper] Michael Poyurovsky, Ronit Weizman, Abraham Weizman, Lorrin Koran
poster:temoigneur
thread:820264
URL: http://www.dr-bob.org/babble/20080412/msgs/824373.html