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Meta-Analysis
. 2021 Nov 4;22(1):69.
doi: 10.1186/s40360-021-00534-6.

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

Fatemeh Hadi  1 , Shayan Kashefinejad  2 , Leila Kamalzadeh  2 , Saba Hoobehfekr  3 , Mohammadreza Shalbafan  4   5
Affiliations
Meta-Analysis

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

Fatemeh Hadi et al. BMC Pharmacol Toxicol. .

Abstract

Background: Obsessive-compulsive disorder (OCD) is among the most disabling neuropsychiatric conditions characterized by the presence of repetitive intrusive thoughts, impulses, or images (obsessions) and/or ritualized mental or physical acts (compulsions). Serotonergic medications, particularly Selective Serotonin Reuptake Inhibitors (SSRIs), are the first-line treatments for patients with OCD. Recently, dysregulation of glutamatergic system has been proposed to be involved in the etiology of OCD. We designed this systematic review and meta-analysis to evaluate clinical efficacy of glutamatergic medications in patients with OCD, according to the guidelines of Cochrane collaboration.

Method: We searched Medline, Scopus, and Cochrane library without applying any language filter. Two of the authors independently reviewed search results for irrelevant and duplicate studies and extracted data and assessed methodological quality of the studies. We transformed data into a common rubric and calculated a weighted treatment effect across studies using Review Manager.

Results: We found 476 references in 3 databases, and after exclusion of irrelevant and duplicate studies, 17 studies with total number of 759 patients with OCD were included. In the present review we found evidence for several drugs such as memantine, N-acetylcysteine (NAC), Minocycline, L-carnosine and riluzole. Glutamaterigic drug plus SSRIs were superior to SSRI+ Placebo with regard to Y-BOCS scale [standardized mean difference (SMD = - 3.81 95% CI = - 4.4, - 3.23).

Conclusion: Augmentation of glutamatergic medications with SSRIs are beneficial in obsessive-compulsive patients, no harmful significant differences in any safety outcome were found between the groups.

Keywords: Glutamate; Memantine; Minocycline; Obsessive-compulsive disorder; Riluzole; Systematic review.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Flowchart of study selection for systematic review and meta-analysis of Glutamatergic Medications as Adjunctive Therapy for Moderate to Severe Obsessive-Compulsive Disorder in Adults
Fig. 2
Fig. 2
Comparison of Y-BOCS score between patients with moderate to severe OCD groups and control groups in each of the studies and in overall meta-analysis
Fig. 3
Fig. 3
Funnel Plot graph for the studies included in the Meta-Analysis. The asymmetry in the funnel plot may be due to heterogeneity of samples. It means that a subgroup of OCD patients may benefit more from glutamatergic drugs than other groups
See this image and copyright information in PMC

References

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