| Summary: | 碩士 === 中國醫藥大學 === 醫學研究所碩士班 === 95 === Background : Although serotonin reuptake inhibitors (SRIs) are the medications of choice for obsessive compulsive disorder (OCD), only 40-60% of patients respond to a single trial of any of these agents. Usually, the maximum response is only partial. Hyperactivity in cortico–striatal -thalamic circuits of the brain in patients with OCD may be due to an imbalance between tonic and phasic glutamatergic release in striato-pallidal pathways. The associations of glutamatergic transmission with OCD had been implicated by evidences from families’ studies with genomic scan and genetic polymorphism studies on N-methyl-D-aspartate receptor (NMDA-R) subunits. N-methylglycine (sarcosine) is an endogenous antagonist of glycine transporter-1, which potentiates glycine''s action on NMDA-R glycine site. In this open label study, we investigated the efficacy of sarcosine in treatment of OCD.
Method : Nine psychiatric outpatients aged between 20 and 63 with a primary diagnosis of OCD had completed 10 weeks’ treatment with sarcosine. Five of them received sarcosine as mono-therapy and 4 of them as an adjuvant to their current SRIs therapies. Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) scores were obtained biweekly.
Result: Y-BOCS scores improved significantly over time in two drug-naïve patients and a patient with combination treatment. There was no significant improvement in Y-BOCS scores in patients who failed more than 2 standard treatments with SRIs. For responders, the time intervals to achieve criteria of response (more than 35% decrease of Y-BOCS scores) were within 2 weeks of sarcosine treatment at relatively low dose.
Conclusion: In the future, double blind, placebo controlled trials comparing the clinical efficacies between sarcosine and an SRI, in combination with genetic studies focusing on the glutamatergic neurotransmission, is suggested.
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