Naltrexone augmentation in OCD: a double-blind placebo-controlled cross-over study

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Current Obsessive Compulsive Disorder (OCD) treatments primarily target serotonergic pathways.
• A significant portion of patients (around 30%) exhibit treatment resistance to serotonin reuptake inhibitors (SRIs).
• Obsessive compulsive behaviors share similarities with addiction, suggesting potential alternative therapeutic targets.

Purpose of the Study:

• To investigate the efficacy of naltrexone, an opioid antagonist, as an adjunctive treatment for SRI-resistant OCD.
• To evaluate whether naltrexone can attenuate compulsive behaviors in patients with Obsessive Compulsive Disorder.

Main Methods:

• A randomized, double-blind, cross-over study involving 10 outpatients with treatment-resistant OCD.
• Patients received either naltrexone or placebo augmentation to their existing SRI treatment for 5 weeks, followed by a 1-week taper.
• Weekly assessments included the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A), and Montgomery-Åsberg Depression Rating Scale (MADRS).

Main Results:

• Naltrexone augmentation did not yield statistically significant improvements in Y-BOCS scores for OCD symptoms.
• Patients receiving naltrexone showed significantly higher scores on CGI, MADRS, and HAM-A compared to placebo.
• These findings suggest naltrexone may not be effective for OCD symptom reduction and could potentially exacerbate anxiety and depression.

Conclusions:

• Naltrexone augmentation to SRIs does not appear to be effective in treating Obsessive Compulsive Disorder symptoms.
• The observed increase in anxiety and depression scores warrants further investigation into potential non-specific adverse effects.
• Alternative therapeutic strategies are needed for patients with treatment-resistant OCD.