Double-Blind Treatment With Oral Morphine in Treatment-Resistant Obsessive-Compulsive Disorder

Koran, Lorrin M.; Aboujaoude, Elias; Bullock, Kim; Franz, Bettina; Gamel, Nona N.; Elliott, Michael A.

doi:10.4088/jcp.v66n0312

Cited by 100 publications

(52 citation statements)

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“…A once a week opioid receptor agonist trial in OCD patients has shown some success and is under investigation. 59 Since potential adversities of these treatments are high they should probably still be conducted only in specialized centers under scrutiny of researchers and with explicit informed consents until more evidence is gathered.…”

Section: Pharmacologicalmentioning

confidence: 99%

Treatment-resistant anxiety disorders

2006

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Several epidemiological studies confirmed that Anxiety Disorders as a group are the most prevalent psychiatric conditions in the United States. The importance of these conditions is underlined by the fact that they cause significant disability, poor quality of life, alcohol and drug abuse. Anxiety disorders are treatable conditions and respond to the front-line interventions such as serotonin reuptake inhibitors and cognitive behavioral therapy. However, only about 60% of patients respond to those treatments to any significant degree. Many still have residual symptoms or stay treatment refractory. The group of anxiety patients that is resistant to the treatment has been shown to have very poor quality of life and have highest rate of suicidal attempts than any other disorders. Many biological, treatment specific and social factors are affecting treatment resistance. In this paper, we are attempting to review reasons for the treatment resistance. In addition, we would like to review current strategies that could be helpful in reducing treatment resistance and aiding people chronically suffering from these severe and disabling conditions.

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Section: Pharmacologicalmentioning

confidence: 99%

Treatment-resistant anxiety disorders

2006

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“…62 A smaller number of studies have examined the utility of augmentation therapy with opioid agents. Morphine given once weekly has shown efficacy in treatment-resistant obsessive-compulsive disorder in a single doubleblind study, 63 and administration of the opioid agonist tramadol hydrochloride has also been shown to diminish OCD symptoms. 64,65 The mechanism of this interesting effect is unknown, but opioids may inhibit glutamate release in cortex via disinhibition of serotonergic neurons.…”

Section: Augmentation Therapymentioning

confidence: 99%

Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder

Pittenger

Krystal

Coric

2006

NeuroRX

188

128

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Summary:Obsessive-compulsive disorder (OCD) is a common psychiatric disorder that produces significant morbidity. The introduction of serotonin reuptake inhibitors in the 1980s represented an important advance in the treatment of OCD. However, few patients show complete remission of their symptoms, and some patients show minimal improvement with existing treatments. We review current treatment strategies and initial data supporting the efficacy of glutamate modulating agents as a novel class of pharmaceuticals for the treatment of OCD. Functional neuroimaging studies repeatedly reported metabolic hyperactivity in the cortico-striato-thalamo-cortical circuitry in patients with OCD. Recent magnetic resonance spectroscopy studies provide evidence of elevated glutamate levels in several brain regions in patients suffering from OCD.These findings raised the possibility that agents that reduce glutamate hyperactivity or its consequences in the CNS might be efficacious as novel therapeutic interventions. Indeed, initial evidence from our group suggests that the antiglutamatergic agent riluzole (Rilutek), which was developed for the treatment of amyotrophic lateral sclerosis, is effective in treatment-resistant OCD. Case reports suggest that other agents that modulate glutamatergic activity may likewise be effective. This new application of glutamate modulating agents holds promise for the treatment of this disabling and often inadequately treated disease.

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“…Á A double-blind cross-over study compared morphine, lorazepam, and placebo in treatmentrefractory patients with OCD. Only one patient on morphine showed sufficient response (Koran et al 2005a)(C2). Á In a small DBPC cross-over study with 10 treatment-refractory patients, the opioid antagonist naltrexone did not improve OCD symptoms, but even led to and exacerbation of anxiety and depression (Amiaz et al 2008)(E).…”

Section: Treatment-resistantmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

699

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Double-Blind Treatment With Oral Morphine in Treatment-Resistant Obsessive-Compulsive Disorder

Cited by 100 publications

References 0 publications

Treatment-resistant anxiety disorders

Treatment-resistant anxiety disorders

Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

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