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Serotonin reuptake inhibitors (SRIs) are the first-line pharmacologic treatment for obsessive-compulsive disorder. However, many patients remain symptomatic despite adequate trials of SRIs. Various augmentation agents have been tested, with haloperidol, risperidone, quetiapine, olanzapine, and pindolol showing efficacy in double-blind trials. In a retrospective case series, these authors examined the efficacy of augmenting an SRI with the anticonvulsant topiramate for treatment-resistant OCD. Topiramate has inhibitory effects on glutamate, and an imaging study has found decreased caudate glutamatergic activity in patients whose OCD symptoms were reduced with treatment.
The subjects were 16 consecutive patients (mean age, 41) whose OCD was un…