Acúfenos: Sección tratamiento nutricional

Nutraceuticals in the treatment of obsessive compulsive disorder (OCD): A review of mechanistic and clinical evidence

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David A. Camfield^{a, , ,} , Jerome Sarris^{a, b} and Michael Berk^{b, c, d, e}

^a National Institute of Complementary Medicine (NICM) Collaborative Centre for Neurocognition, Brain Sciences Institute, Swinburne University of Technology, Melbourne, Australia
^b The University of Melbourne & The Melbourne Clinic Faculty of Medicine, Department of Psychiatry, Melbourne, Australia
^c Deakin University, Geelong, Australia
^d The Mental Health Research Institute, Parkville, Australia
^e Orygen Youth Health Research Institute, Parkville Australia

Received 7 January 2011; 

revised 10 February 2011; 

accepted 16 February 2011. 

Available online 23 February 2011.

Abstract

Obsessive-Compulsive Disorder (OCD) is a debilitating mental illness which has a significant impact on quality of life.

First-line SSRI treatments for OCD typically are of limited benefit to only 40-60% of patients, and are associated with a range of adverse side effects.

Current preclinical research investigating nutraceuticals (natural products) for OCD, reveals encouraging novel activity in modulating key pathways suggested to be involved in the pathogenesis of OCD (glutamatergic and serotonergic pathway dysregulation).
Emerging clinical evidence also appears to tentatively support certain nutrients and plant-based interventions with known active constituents which modulate these pathways:
N-acetlycysteine, myo-inositol, glycine, and milk thistle (Silybum marianum).
The serotonin precursor tryptophan is unlikely to be of use in treating OCD while 5-HTP may possibly be a more effective precursor strategy.
However, there is currently no clinical evidence to test the efficacy of either of these substances.
Currently the balance of clinical evidence does not support the use of St. John's wort (Hypericum perforatum) in OCD.
While clinical research in this area is in its infancy, further research into nutraceuticals is warranted in light the promising preclinical data regarding their mechanisms of action and their favourable side effect profiles in comparison to current SSRI treatments.
It is recommended that future clinical trials of nutraceutical treatments for OCD utilise randomised placebo-controlled study designs and considerably larger sample sizes in order to properly test for efficacy.

Research Highlights

►Glutamatergic and Serotonergic mechanisms of action of nutraceutical substances with the potential to treat OCD are reviewed.
►Clinical evidence from preliminary human trials using nutraceutical substances for the treatment of OCD are also reviewed, and their side effect profile compared to current SSRI treatments.
►N-acetylcysteine and glycine, which modulate glutamatergic pathways in the CNS, are substances which may potentially be effective treatments for OCD; and are worthy of further clinical research in randomized controlled trials.
►Myo-Inositol may also potentially have efficacy as a monotherapy for OCD due to a putative mechanism of serotonergic modulation; yet larger scale clinical studies are also required.
►The plant-based substance milk thistle may also have poetntial efficacy in the treatment of OCD due to modulation of serotonergic pathways, although much further research is required.
►The weight of current evidence suggests that neither tryptophan, 5-HTP or St. John's Wort have any efficacy in the treatment of OCD.

Keywords: Obsessive Compulsive Disorder, OCD; Anxiety; Nutracuetical; N-acetylcysteine; Glycine; Myo-inositol; Tryptohan; 5-HTP; St John's wort; Milk thistle

Abbreviations: 5-HT, Serotonin; 5-HTP, 5-hydroxytryptophan; CSTC, Cortico-Striatal-Thalamo-Cortical; CSF, Cerebrospinal Fluid; DAG, Diacylglycerol; ERP, Exposure and Response Prevention therapy; GABA, Gamma Amino Butyric Acid; Glx, A composite measure of glutamate, glutamine, homocaronsine and GABA; GSH, Glutathione; LNAA, Large Netural Amino Acid; MAO, Monoamine Oxidase; MDD, Major Depressive Disorder; mGlu, Metabotropic glutamate receptor; MI, Myo-Inositol; MRS, Magnetic Resonance Spectroscopy; NAC, N-Acetylcysteine; NMDA, N-Methyl-D-Aspartate; PIP₂, Phosphatidyl-inositol-(4–5) bisphosphate; PIP₃, Inositol 1,4,5-trisphosphate; PKC, Protein Kinase C; PI cycle, Phosphoinositide secondary messenger cycle; SJW, St. John's Wort - Hypericum perforatum; SNRI, Serotonin and Norepinephrine Reuptake Inhibitor; SSRI, Selective Serotonin Reuptake Inhibitor; Y-BOCS, Yale-Brown Obsessive Compulsive Scale

Corresponding author at: PO Box 218 Hawthorn, Vic, 3122 AUSTRALIA. Tel.: + 61 0392148259, + 61 42008578; fax + 61 3 9214 5230. 

Fuente: Progress in Neuro-Psychopharmacology and Biological Psychiatry

Nota. Algunos pacientes con acúfenos presentan caraceristicas clinicas de padecer tambien un Sindrome Obsesivo compulsivo, de alli el interes de este trabajo 
Dr. Dario Roitman
Centro de Acúfenos Buenos Aires.