Anxiety and OCD

Anxiety and OCD

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by recurrent, intrusive, and anxiety-provoking thoughts or images (obsessions) associated with repetitive physical or mental rituals (compulsions) aimed at relieving the discomfort associated with the obsessions.

Treatment guidelines recommend serotonin reuptake inhibitors (SRIs) as first-line pharmacologic treatment for OCD. Approximately half of OCD patients treated with 1 adequate trial of SRIs fail to fully respond to treatment.

OCD is associated with hyperactivity in cortical-striatum-thalamus-cortical (CSTC) circuits. Corticostriatal and thalamostriatal afferents use the excitatory neurotransmitter glutamate, and evidence suggests abnormal glutamate levels and/or homeostasis in OCD patients. Thus, researchers have been testing glutamate-modulating medications, such as memantine, topiramate, ketamine, lamotrigine and N-acetylcysteine (NAC) as augmentation agents in treatment-resistant OCD, with some evidence for efficacy. We assist with choosing different medication and supplements alternatives to treatment of OCD. We also have additional resources of connecting patients to providers who offer Ketamine for treatment resistant OCD.

Pittenger C. June 2015. Glutamate modulators in the treatment of obsessive-compulsive disorder.  Psychiatric Annals.

Rodriguez CI, Kegeles LS, Levinson A, Feng T, Marcus SM, Vermes D, Flood P, Simpson HB. November 2013. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology. 38(12):2475-83. doi: 10.1038/npp.2013.150. Epub 2013 Jun 19.

 

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