Abstract
Rationale
Dysfunction of glutamatergic neurotransmission has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD) and recent clinical reports suggest that some glutamate modulating agents are efficacious in the treatment of this disorder. N-acetylcysteine (NAC) is a readily available amino acid compound that is thought to attenuate glutamatergic neurotransmission. NAC may be useful in treating psychiatric disorders involving glutamatergic dysfunction such as OCD.
Objectives
To examine the efficacy of augmentation with NAC in a patient with serotonin reuptake inhibitor (SRI)-refractory OCD.
Methods
A patient with SRI-refractory OCD was treated with an off-label use of NAC augmentation of fluvoxamine over several weeks.
Results
NAC augmentation of fluvoxamine resulted in a marked decrease in Yale-Brown Obsessive Compulsive Scale (Y-BBOCS) score and a clinically significant improvement in OCD symptoms.
Conclusions
NAC augmentation was effective in treating SRI-refractory OCD in this single case. Further research is warranted to investigate the use of NAC and other glutamate modulating agents in the treatment of OCD.
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Acknowledgements
The authors would like to thank the clinical staff of the Clinical Neuroscience Research Unit of the Connecticut Mental Health Center for their contributions to the clinical management of the patient in this report. The authors acknowledge support from the State of Connecticut for the Abraham Ribicoff Research Facilities, the National Alliance for Research on Schizophrenia and Depression Young Investigator Award (NARSAD 2003, 2005, V.C.), the NIH Loan Repayment Program (V.C.), the NIMH support for the Yale Neuroscience Research Training Program (C.P.), the U.S. Department of Veterans Affairs (J.K.), and the National Institute on Alcohol Abuse and Alcoholism (KO5 AA 14906-01, J.K.). The treatment described below was conducted in accordance with the current laws of the State of Connecticut and of the United States of America.
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Lafleur, D.L., Pittenger, C., Kelmendi, B. et al. N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder. Psychopharmacology 184, 254–256 (2006). https://doi.org/10.1007/s00213-005-0246-6
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DOI: https://doi.org/10.1007/s00213-005-0246-6