Memantine for OCD

[cbrons]

What is your experience with it?
I have only used it in one very severe case (young man who was in residential ERP treatment for 2 months and refused to take SSRIs) and it worked pretty well (I think).

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[Yoyomama88]

I really want to try it. I read that apparently ketamine can work for ocd, so the glutamate and nmda mechanism makes sense

 

[clausewitz2]

I've used it a fair amount since I treat lots of OCD. It seems about as effective as Abilify as a third line after moving through SSRIs at adequate doses (400 mg sertraline or equivalent) and clomipramine at adequate dose (250 mg). I've seen more dramatic improvement with riluzole but then memantine is so very much cheaper. I think memantine probably deserves a trial before neuroleptics for OCD these days based on evidence base.

Edit: one exception might be for young people in that OCD/Tourette's cluster with lots of symmetry, just right, and harm obsessions. Them I probably bust out neuroleptics before memantine.

 

[Stagg737]

I've used it a fair amount since I treat lots of OCD. It seems about as effective as Abilify as a third line after moving through SSRIs at adequate doses (400 mg sertraline or equivalent) and clomipramine at adequate dose (250 mg). I've seen more dramatic improvement with riluzole but then memantine is so very much cheaper. I think memantine probably deserves a trial before neuroleptics for OCD these days based on evidence base.

Edit: one exception might be for young people in that OCD/Tourette's cluster with lots of symmetry, just right, and harm obsessions. Them I probably bust out neuroleptics before memantine.

Is the bold a typo or just something I’m not understanding?

 

[clausewitz2]

Is the bold a typo or just something I’m not understanding?

100% a typo

 

[Merovinge]

I've used it a fair amount since I treat lots of OCD. It seems about as effective as Abilify as a third line after moving through SSRIs at adequate doses (400 mg sertraline or equivalent) and clomipramine at adequate dose (250 mg). I've seen more dramatic improvement with riluzole but then memantine is so very much cheaper. I think memantine probably deserves a trial before neuroleptics for OCD these days based on evidence base.

Edit: one exception might be for young people in that OCD/Tourette's cluster with lots of symmetry, just right, and harm obsessions. Them I probably bust out neuroleptics before memantine.

Are you indicating primarily using monotherapy in these cases? The few patients I have on Abilify for OCD it's being used adjunctively with high dose SSRI when the SSRI makes some improvement but remains with crippling symptoms. Would memantine be used similarly?

 

[clausewitz2]

Are you indicating primarily using monotherapy in these cases? The few patients I have on Abilify for OCD it's being used adjunctively with high dose SSRI when the SSRI makes some improvement but remains with crippling symptoms. Would memantine be used similarly?

Yes, this is basically always used as an adjunct.

 

[cbrons]

Yes, this is basically always used as an adjunct.

Always? You haven't seen people with success using it alone?

 

[clausewitz2]

Always? You haven't seen people with success using it alone?

I rarely see people with OCD on monotherapy that does not involve SRIs of some description unless they have really intolerable side effects, so hard to say. If I had to pick a most common non-SRI monotherapy I have ended up working with in OCD it'd be NAC for the 'i hate medicines but give me a nutraceutical pill' crowd.

Perhaps unsurprisingly many people with OCD have spent a lot of time researching OCD and tend to have a strong preference for the 'correct' treatments, and every website you find will mention SSRIs, so...

 

[Merovinge]

Perhaps unsurprisingly many people with OCD have spent a lot of time researching OCD and tend to have a strong preference for the 'correct' treatments, and every website you find will mention SSRIs, so...

Next your going to tell me plastic surgeons like things done a certain way. Get out of here with these ridiculous stereotypes 😆.

 

[birchswing]

I've been following a prodrug of riluzole that's supposed to have fewer side effects and may seek (receive?) approval specifically for OCD:

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