D-Amphetamine in obsessive-compulsive disorder

Abstract

In a double-blind crossover study, single doses of d-amphetamine and placebo were administered to 12 patients with severe chronic obsessive-compulsive disorder (OCD). Improvement of obsessional symptoms was significant on clinical ratings and was correlated with improved performance on an attention task. Changes were also significant for self-rated measures of activation and altered reality. The behavior response to amphetamine was not statistically correlated with subsequent improvement during a 6-week clomipramine trial, although the direction of change was the same during both treatments for every patient studied.

The Role of the Striatum in Compulsive Behavior in Intact and Orbitofrontal-Cortex-Lesioned Rats: Possible Involvement of the Serotonergic System

“…Specifically, the findings that serotonin reuptake inhibitors are effective in alleviating obsessions and compulsions in patients have directed much attention to the involvement of the serotonergic system in OCD (for review see Sasson and Zohar, 1996;Stein, 2000), with more recent studies implicating specific serotonin receptors (most notably 5-HT1a, 5-HT2a, and 5-HT2c) in the pathophysiology of OCD and in the response to treatment (for review see El Mansari and Blier, 2006;Goddard et al, 2008;Van Oekelen et al, 2003). Abnormalities of the dopaminergic system have been implicated in OCD on the basis of several lines of clinical and preclinical evidence (for review see Denys et al, 2004), including changes in OC symptoms following the administration of amphetamine and cocaine to OCD patients (Insel et al, 1983;Leonard and Rapoport, 1987;McDougle et al, 1989), and the surplus therapeutic benefits obtained with co-administration of SSRIs and dopaminergic blockers (McDougle et al, 1994;Sasson and Zohar, 1996;Saxena et al, 1996). Involvement of the striatum (mainly the caudate nucleus) in OCD has been derived mainly from functional imaging studies revealing higher metabolic activity in this region in OCD patients compared to healthy controls, and metabolic normalization following a successful behavioral or SSRI treatment (Baxter et al, 1992;Saxena et al, 1999).…”

Pharmacological Treatment of Obsessive-Compulsive Disorder

“…An openlabel study suggested that tramadol (an agonist at the u opioid receptor as well as a modulator of noradrenergic and serotonergic systems) might be effective in OCD (Shapira et al 1997). Other small studies suggested that stimulants (and specifically D-amphetamine) might reduce OCD symptoms (Insel et al 1983;Joffe and Swinson 1987;Joffe et al 1991).…”

Obsessive–compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults

“…Adjunctive pregabalin has been investigated in an open-label case series only, with some signs of possible efficacy (Oulis et al, 2011), as has gabapentin (Corá-Locatelli et al, 1998). A randomized placebo-controlled trial of single dose d-amphetamine produced short-lived benefits (Insel et al, 1983a), while another randomized controlled trial comparing d-amphetamine and caffeine intriguingly noted that both compounds were associated with rapid improvement of obsessive compulsive symptoms within a week (Koran et al, 2009), hinting that stimulants such as d-amphetamine could play a role in treating OCD, possibly in the context of comorbid ADHD.…”