5-Hydroxytryptophan as adjuvant therapy in treatment of moderate to severe obsessive-compulsive disorder: a double-blind randomized trial with placebo control

Abstract

On the basis of numerous previous studies, the serotonergic system plays a role in the pathogenesis of obsessive-compulsive disorder (OCD) and effective agents in this pathway, such as 5-hydroxytryptophan, can potentially contribute to treatment of patients with this disorder. Evaluating the efficacy of 5-hydroxytryptophan in treating OCD was the aim of the present randomized, double-blind, placebo-controlled 12-week trial. In a 12-week, randomized double-blind study, 60 patients with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of moderate to severe OCD and a Yale–Brown Obsessive Compulsive Scale (Y-BOCS) score of >21 were randomly assigned to receive either fluoxetine plus placebo or fluoxetine plus 5-hydroxytryptophan (100 mg twice daily). All patients, regardless of their treatment group, received fluoxetine at 20 mg/day for the initial 4 weeks of the study followed by 60 mg/day of fluoxetine for the rest of the trial course. Symptoms were assessed using the Y-BOCS at baseline and weeks 4, 8 and 12. General linear model repeated measure showed significant effects for time × treatment interaction on total Y-BOCS (F = 12.07, df = 2.29, P-value <0.001), obsession (F = 8.25, df = 1.91, P-value = 0.001) and compulsion subscale scores (F = 6.64, df = 2.01, P-value = 0.002). 5-Hydroxytryptophan augmentation therapy demonstrated higher partial and complete treatment response rate (P = 0.032 and P = 0.001, respectively) according to the Y-BOCS total scores. The results of this study confirm that 5-hydroxytryptophan may be effective as an augmentative agent in treatment of moderate-to-severe OCD.

Obsessive-compulsive symptoms in major depressive disorder correlate with clinical severity and mixed features

“…In fact, OCS showed a clearcut association with the lack of antidepressant response, which was confirmed after controlling for potentially confounding variables such as baseline depression severity and bipolar clinical risk score. This finding may suggest the use of specific treatments for these patients (De Berardis et al, 2020;Fineberg et al, 2020;Yousefzadeh et al, 2020;Poyurovsky, et al, 2021). Conversely, OCS had no impact on the risk of hypomanic switch during antidepressant use.…”

Memantine augmentation of sertraline in the treatment of symptoms and executive function among patients with obsessive-compulsive disorder: A double-blind placebo-controlled, randomized clinical trial

“…Y-BOCS was used for assessment of patients at baseline and at weeks 0, 4, 8, and 12 of therapy. Y-BOCS provides a rating scale for severity of obsessive-compulsive symptoms [ 54 , 58 , 59 ]. This clinician-rated scale contains 10 questions, each item rated from 0 (no symptoms) to 4 (extreme symptoms) [ 60 ].…”

“…This clinician-rated scale contains 10 questions, each item rated from 0 (no symptoms) to 4 (extreme symptoms) [ 60 ]. The psychometric properties of the Persian version of Y-BOCS are approved in previous studies [ 23 , 25 , 59 ].…”

Granisetron-mediated augmentation of sertraline therapeutic effect in obsessive-compulsive disorder: a double-blind placebo-controlled, randomized clinical trial

“…This clinician-rated scale contains 10 questions, each item rated from 0 (no symptoms) to 4 (extreme symptoms) [27]. The psychometric properties of the Persian version of Y-BOCS are approved in previous studies [28][29][30].…”