Drug Name | FDA Approval | Mechanism(s) of Action | OCD Studies | Effectiveness |
---|---|---|---|---|
riluzole | ALS | reduction of synaptic glutamate release via multiple presynaptic mechanisms; stimulation of glutamate uptake by astocytes | Pittenger et al. 2008 [135] Coric et al. 2005 [130] Grant et al. 2007 [132] Coric et al. 2003 [129] Coric et al. 2007 [134] |
slightly more than half of the 32 total OCD patients treated open-label with riluzole have shown significant improvements |
topiramate | epilepsy | block of voltage-dependent Na+ and K+ channels; reduction of AMPA/kainate receptor channel conductance; positive modulatory actions on GABAA receptors | Van Ameringen et al. 2006 [137] Hollander & Dell'Osso, 2006 [138] *Ozkara et al. 2005 [140] |
12/17 cases showed improvements; topiramate induced OCD symptoms in one isolated case report |
lamotrigine | epilepsy, bipolar disorder | inhibition of voltage-dependent Na+ channels to reduce synaptic glutamate release from neurons | Kumar & Khanna, 2000 [139] *Alkin et al. 2007 [141] *Kuloglu et al. 2008 [142] *Kemp et al. 2007 [143] |
1/8 OCD patients showed benefit; lamotrigine induced OCD symptoms in 7 cases from 3 other studies |
N-acetylcysteine | acetaminophen toxicity | stimulation of the glial cystine/glutamate exchanger resulting in activation of mGluR2 receptors which dampens presynaptic glutamate release from neurons during bouts of excessive neuronal activity | Lafleur et al. 2006 [146] | a single case report indicates potential benefit as augmenting agent |
LY354740 | N/A | agonist of type II metabotropic glutamate receptors; dampens presynaptic glutamate release from neurons during bouts of excessive neuronal activity | No studies in OCD patients | N/A |
memantine | Alzheimer's disease | NMDA-type glutamate receptor open-channel blocker (moderate antagonist relative to dizocilpine) | Pasquini & Biondi, 2006 [150] Poyurovsky et al. 2005 [151] |
2/3 OCD patients treated with memantine showed improvements |
amantadine | influenza A virus infection, Parkinson's disease | NMDA-type glutamate receptor open-channel blocker (moderate antagonist relative to dizocilpine) | No studies in OCD patients | N/A |
dizocilpine (MK-801) | N/A | NMDA-type glutamate receptor open-channel blocker (high-affinity antagonist relative to memantine/amantadine) | No studies in OCD patients | exacerbates OCD symptoms in the D1CT mouse model [154] |
D-cycloserine (DCS) | antibiotic treatment for tuberculosis | partial agonist of NMDA-type glutamate receptors | Wilhelm et al. 2008 [160] Kushner et al. 2007 [161] ^Storch et al. 2007 [162] |
optimal DCS administration may improve treatment response when combined with behavioral therapy |