Effectiveness and Safety of Memantine Add-on Treatment for Refractory Obsessive-Compulsive Disorder: A Meta-Analysis

Area of Science:

• Psychiatry and Mental Health
• Pharmacology
• Clinical Research

Background:

• Obsessive-compulsive disorder (OCD) is a debilitating mental illness impacting daily life and social functioning.
• Refractory OCD cases present significant treatment challenges, necessitating novel therapeutic strategies.
• Memantine, an NMDA receptor antagonist, has shown potential in various neuropsychiatric conditions.

Purpose of the Study:

• To conduct a meta-analysis assessing the efficacy and safety of memantine as an augmentation therapy for refractory OCD.
• To evaluate the impact of memantine dosage and treatment duration on treatment outcomes.
• To synthesize evidence from randomized controlled trials to inform clinical practice.

Main Methods:

• A systematic search of multiple databases was performed from inception to January 2024.
• A random-effects meta-analysis was conducted, including subgroup analyses for dose and duration.
• Seven randomized controlled trials with 315 participants were included, despite observed heterogeneity.

Main Results:

• Memantine augmentation demonstrated significant superiority over placebo in treating OCD (SMD = -1.17, p = 0.02).
• Subgroup analysis indicated memantine significantly reduced compulsive behaviors (SMD = -0.99, p < 0.001).
• Significant improvements in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were observed after eight weeks at 20 mg/day (SMD = -1.06, p = 0.003).
• A mild rash was the primary adverse event noted (RR = 7.00, p = 0.02).

Conclusions:

• Memantine augmentation is a safe and effective strategy for treating refractory OCD.
• Optimal efficacy was observed with memantine at 20 mg/day for a minimum of eight weeks.
• Further research may explore memantine's long-term effects and optimal use in diverse OCD populations.