Memantine Augmentation in Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Obsessive-compulsive disorder (OCD) presents treatment challenges.
• Glutamatergic dysregulation is a proposed mechanism in OCD.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials (RCTs) of adjunctive memantine versus placebo for OCD.
• To assess the efficacy and tolerability of memantine in OCD treatment.

Main Methods:

• Searched multiple databases for RCTs of adjunctive memantine in adults with OCD.
• Analyzed primary outcome (Yale-Brown Obsessive Compulsive Scale score) using random-effects models.
• Assessed risk of bias and certainty of evidence.

Main Results:

• Six RCTs (n=288) were included; memantine showed no significant symptom reduction versus placebo (MD -3.74, 95% CI -9.95 to 2.47) with high heterogeneity.
• A trend towards benefit was observed in treatment-resistant populations, though imprecise.
• Tolerability was comparable to placebo, with no clear excess adverse events or discontinuations.

Conclusions:

• Memantine is not recommended for routine OCD treatment.
• A hypothesis-generating signal for treatment-resistant OCD exists, potentially supporting cautious off-label use.
• An adequately powered RCT in refractory OCD is needed.