L-theanine combination therapy with fluvoxamine in moderate-to-severe obsessive-compulsive disorder: A placebo-controlled, double-blind, randomized trial.


Journal

Psychiatry and clinical neurosciences
ISSN: 1440-1819
Titre abrégé: Psychiatry Clin Neurosci
Pays: Australia
ID NLM: 9513551

Informations de publication

Date de publication:
Sep 2023
Historique:
revised: 19 04 2023
received: 25 02 2023
accepted: 08 05 2023
medline: 5 9 2023
pubmed: 12 5 2023
entrez: 11 5 2023
Statut: ppublish

Résumé

The main aim of this study was to investigate the additional effects of L-theanine, an amino acid in tea and an analog of glutamate with neuroprotective and anti-depressant properties, on obsessive-compulsive disorder (OCD) symptoms in combination with fluvoxamine. Patients from either sex aged between 18 and 60 years diagnosed with OCD, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of more than 21 were enrolled in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either L-theanine (100 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 5) or placebo and fluvoxamine. The primary outcome of interest in this study was the Y-BOCS total score decrease from baseline. From a total of 95 evaluated patients, 50 completed our study; 30 were randomly assigned to each group. Multivariate analysis (ANOVA) showed a significant effect of time Findings in this study suggest L-theanine as a relatively safe and effective adjuvant therapy for moderate to severe OCD.

Identifiants

pubmed: 37169515
doi: 10.1111/pcn.13565
doi:

Substances chimiques

Fluvoxamine O4L1XPO44W
theanine 8021PR16QO
Selective Serotonin Reuptake Inhibitors 0
Glutamates 0

Types de publication

Randomized Controlled Trial Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

478-485

Subventions

Organisme : Tehran University of Medical Sciences and Health Services
ID : 49647

Informations de copyright

© 2023 The Authors. Psychiatry and Clinical Neurosciences © 2023 Japanese Society of Psychiatry and Neurology.

Références

Hirschtritt ME, Bloch MH, Mathews CA. Obsessive-compulsive disorder: Advances in diagnosis and treatment. JAMA 2017; 317: 1358-1367.
Milad MR, Rauch SL. Obsessive-compulsive disorder: Beyond segregated cortico-striatal pathways. Trends Cogn. Sci. 2012; 16: 43-51.
Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am. J. Psychiatry 2007; 164: 5-53.
Robbins TW, Vaghi MM, Banca P. Obsessive-compulsive disorder: Puzzles and prospects. Neuron 2019; 102: 27-47.
Pittenger C, Bloch MH, Williams K. Glutamate abnormalities in obsessive compulsive disorder: Neurobiology, pathophysiology, and treatment. Pharmacol. Ther. 2011; 132: 314-332.
Goodman WK, Storch EA, Sheth SA. Harmonizing the neurobiology and treatment of obsessive-compulsive disorder. Am. J. Psychiatry 2021; 178: 17-29.
Haghighi M, Jahangard L, Mohammad-Beigi H et al. In a double-blind, randomized and placebo-controlled trial, adjuvant memantine improved symptoms in inpatients suffering from refractory obsessive-compulsive disorders (OCD). Psychopharmacology (Berl) 2013; 228: 633-640.
Ghaleiha A, Entezari N, Modabbernia A et al. Memantine add-on in moderate to severe obsessive-compulsive disorder: Randomized double-blind placebo-controlled study. J. Psychiatr. Res. 2013; 47: 175-180.
Rodriguez CI, Kegeles LS, Levinson A et al. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: Proof-of-concept. Neuropsychopharmacology 2013; 38: 2475-2483.
Pittenger C, Bloch MH, Wasylink S et al. Riluzole augmentation in treatment-refractory obsessive-compulsive disorder: A pilot randomized placebo-controlled trial. J. Clin. Psychiatry 2015; 76: 18360.
Emamzadehfard S, Kamaloo A, Paydary K et al. Riluzole in augmentation of fluvoxamine for moderate to severe obsessive-compulsive disorder: R andomized, double-blind, placebo-controlled study. Psychiatry Clin. Neurosci. 2016; 70: 332-341.
Türközü D, Şanlier N. L-theanine, unique amino acid of tea, and its metabolism, health effects, and safety. Crit. Rev. Food Sci. Nutr. 2017; 57: 1681-1687.
Kakuda T, Nozawa A, Sugimoto A, Niino H. Inhibition by theanine of binding of [3H] AMPA,[3H] kainate, and [3H] MDL 105,519 to glutamate receptors. Biosci. Biotechnol. Biochem. 2002; 66: 2683-2686.
Kakuda T, Hinoi E, Abe A, Nozawa A, Ogura M, Yoneda Y. Theanine, an ingredient of green tea, inhibits [3H] glutamine transport in neurons and astroglia in rat brain. J. Neurosci. Res. 2008; 86: 1846-1856.
Yamada T, Terashima T, Kawano S et al. Theanine, γ-glutamylethylamide, a unique amino acid in tea leaves, modulates neurotransmitter concentrations in the brain striatum interstitium in conscious rats. Amino Acids 2009; 36: 21-27.
Yamada T, Terashima T, Wada K et al. Theanine, r-glutamylethylamide, increases neurotransmission concentrations and neurotrophin mRNA levels in the brain during lactation. Life Sci. 2007; 81: 1247-1255.
Li MY, Liu HY, Wu DT et al. L-Theanine: A unique functional amino acid in tea (Camellia sinensis L.) with multiple health benefits and food applications. Front. Nutr. 2022; 9: 853846.
Goodman WK, Price LH, Rasmussen SA et al. The Yale-brown obsessive compulsive scale: II. Validity. Arch. Gen. Psychiatry 1989; 46: 1012-1016.
Goodman WK, Price LH, Rasmussen SA et al. The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Arch. Gen. Psychiatry 1989; 46: 1006-1011.
Hidese S, Ogawa S, Ota M et al. Effects of L-Theanine administration on stress-related symptoms and cognitive functions in healthy adults: A randomized controlled trial. Nutrients 2019; 11: 2362.
Goodman WK, Price LH, Rasmussen SA, Delgado PL, Heninger GR, Charney DS. Efficacy of fluvoxamine in obsessive-compulsive disorder. A double-blind comparison with placebo. Arch. Gen. Psychiatry 1989; 46: 36-44.
Ordacgi L, Mendlowicz MV, Fontenelle LF. Management of obsessive-compulsive disorder with fluvoxamine extended release. Neuropsychiatr. Dis. Treat. 2009; 5: 301-308.
Öst L-G, Riise EN, Wergeland GJ, Hansen B, Kvale G. Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. J. Anxiety Disord. 2016; 43: 58-69.
Shalbafan M, Mohammadinejad P, Shariat S-V et al. Celecoxib as an adjuvant to fluvoxamine in moderate to severe obsessive-compulsive disorder: A double-blind, placebo-controlled, randomized trial. Pharmacopsychiatry 2015; 48: 136-140.
Pallanti S, Quercioli L. Treatment-refractory obsessive-compulsive disorder: Methodological issues, operational definitions and therapeutic lines. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2006; 30: 400-412.
Khajavi D, Farokhnia M, Modabbernia A et al. Oral scopolamine augmentation in moderate to severe major depressive disorder: A randomized, double-blind, placebo-controlled study. J. Cin. Psychiatry 2012; 73: 13538-11433.
Zeinoddini A, Sorayani M, Hassanzadeh E et al. Pioglitazone adjunctive therapy for depressive episode of bipolar disorder: A randomized, double-blind, placebo-controlled trial. Depress. Anxiety 2015; 32: 167-173.
Jafarinia M, Afarideh M, Tafakhori A et al. Efficacy and safety of oral ketamine versus diclofenac to alleviate mild to moderate depression in chronic pain patients: A double-blind, randomized, controlled trial. J. Affect. Disord. 2016; 204: 1-8.
Perse TL, Greist JH, Jefferson JW, Rosenfeld R, Dar R. Fluvoxamine treatment of obsessive-compulsive disorder. Am. J. Psychiatry 1987; 144: 1543-1548.
McDougle CJ, Goodman WK, Leckman JF, Price LH. The psychopharmacology of obsessive compulsive disorder: Implications for treatment and pathogenesis. Psychiatric Clin. North Am. 1993; 16: 749-766.
Kellner M. Drug treatment of obsessive-compulsive disorder. Dialogues Clin. Neurosci. 2022; 12: 187-197.
Pigott TA, Seay SM. A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder. J. Clin. Psychiatry 1999; 60: 101-106.
Shalbafan M, Malekpour F, Tadayon Najafabadi B et al. Fluvoxamine combination therapy with tropisetron for obsessive-compulsive disorder patients: A placebo-controlled, randomized clinical trial. J. Psychopharmacol. 2019; 33: 1407-1414.
Yamada T, Terashima T, Okubo T, Juneja LR, Yokogoshi H. Effects of theanine, r-glutamylethylamide, on neurotransmitter release and its relationship with glutamic acid neurotransmission. Nutr. Neurosci. 2005; 8: 219-226.
Shen M, Yang Y, Wu Y et al. L-theanine ameliorate depressive-like behavior in a chronic unpredictable mild stress rat model via modulating the monoamine levels in limbic-cortical-striatal-pallidal-thalamic-circuit related brain regions. Phytother. Res. 2019; 33: 412-421.
Yokogoshi H, Kobayashi M, Mochizuki M, Terashima T. Effect of theanine, r-glutamylethylamide, on brain monoamines and striatal dopamine release in conscious rats. Neurochem. Res. 1998; 23: 667-673.
Kim S, Jo K, Hong K-B, Han SH, Suh HJ. GABA and l-theanine mixture decreases sleep latency and improves NREM sleep. Pharm. Biol. 2019; 57: 64-72.
Nathan PJ, Lu K, Gray M, Oliver C. The neuropharmacology of L-theanine (N-ethyl-L-glutamine) a possible neuroprotective and cognitive enhancing agent. J. Herb. Pharmacother. 2006; 6: 21-30.
Kimura K, Ozeki M, Juneja LR, Ohira H. L-Theanine reduces psychological and physiological stress responses. Biol. Psychol. 2007; 74: 39-45.
Hidese S, Ota M, Wakabayashi C et al. Effects of chronic l-theanine administration in patients with major depressive disorder: An open-label study. Acta Neuropsychiatrica 2017; 29: 72-79.
Sakamoto FL, Ribeiro RMP, Bueno AA, Santos HO. Psychotropic effects of L-theanine and its clinical properties: From the management of anxiety and stress to a potential use in schizophrenia. Pharmacol. Res. 2019; 147: 104395.
Sarris J, Byrne GJ, Oliver G et al. Treatment of refractory obsessive-compulsive disorder with nutraceuticals (TRON): A 20-week, open label pilot study. CNS Spectr. 2021; 1-10: 588-597.
Pittenger C, Krystal JH, Coric V. Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder. NeuroRx 2006; 3: 69-81.
Graybiel AM, Rauch SL. Toward a neurobiology of obsessive-compulsive disorder. Neuron 2000; 28: 343-347.
Rosenberg DR, MacMASTER FP, Keshavan MS, Fitzgerald KD, Stewart CM, Moore GJ. Decrease in caudate glutamatergic concentrations in pediatric obsessive-compulsive disorder patients taking paroxetine. J. Am. Acad. Child Adolesc. Psychiatry 2000; 39: 1096-1103.
Chakrabarty K, Bhattacharyya S, Christopher R, Khanna S. Glutamatergic dysfunction in OCD. Neuropsychopharmacology 2005; 30: 1735-1740.
Bhattacharyya S, Khanna S, Chakrabarty K, Mahadevan A, Christopher R, Shankar S. Anti-brain autoantibodies and altered excitatory neurotransmitters in obsessive-compulsive disorder. Neuropsychopharmacology 2009; 34: 2489-2496.
Iijima M, Kurosu S, Chaki S. Effects of agents targeting glutamatergic systems on marble-burying behavior. Neurosci. Lett. 2010; 471: 63-65.
Gomes FV, Casarotto PC, Resstel LB, Guimarães FS. Facilitation of CB1 receptor-mediated neurotransmission decreases marble burying behavior in mice. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2011; 35: 434-438.
Wu K, Hanna GL, Rosenberg DR, Arnold PD. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol. Biochem. Behav. 2012; 100: 726-735.
Rosenberg DR, MacMillan SN, Moore GJ. Brain anatomy and chemistry may predict treatment response in paediatric obsessive-compulsive disorder. Int. J. Neuropsychopharmacol. 2001; 4: 179-190.
Bhattacharyya S, Chakraborty K. Glutamatergic dysfunction-newer targets for anti-obsessional drugs. Recent Pat. CNS Drug Discov. (Discontinued) 2007; 2: 47-55.
Esalatmanesh S, Abrishami Z, Zeinoddini A et al. Minocycline combination therapy with fluvoxamine in moderate-to-severe obsessive-compulsive disorder: A placebo-controlled, double-blind, randomized trial. Psychiatry Clin. Neurosci. 2016; 70: 517-526.
Arabzadeh S, Shahhossenie M, Mesgarpour B et al. L-carnosine as an adjuvant to fluvoxamine in treatment of obsessive compulsive disorder: A randomized double-blind study. Human Psychopharmacol.: Clin. Exp. 2017; 32: e2584.
Aboujaoude E, Barry JJ, Gamel N. Memantine augmentation in treatment-resistant obsessive-compulsive disorder: An open-label trial. J. Clin. Psychopharmacol. 2009; 29: 51-55.
Poyurovsky M, Weizman R, Weizman A, Koran L. Memantine for treatment-resistant OCD. Am. J. Psychiatry 2005; 162: 2191-2192.
Pasquini M, Biondi M. Memantine augmentation for refractory obsessive-compulsive disorder. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2006; 30: 1173-1175.
Greenberg WM, Benedict MM, Doerfer J et al. Adjunctive glycine in the treatment of obsessive-compulsive disorder in adults. J. Psychiatr. Res. 2009; 43: 664-670.
Egashira N, Okuno R, Harada S et al. Effects of glutamate-related drugs on marble-burying behavior in mice: Implications for obsessive-compulsive disorder. Eur. J. Pharmacol. 2008; 586: 164-170.
Hollander E, Dell'Osso B. Topiramate plus paroxetine in treatment-resistant obsessive-compulsive disorder. Int. Clin. Psychopharmacol. 2006; 21: 189-191.
Van Ameringen M, Mancini C, Patterson B, Bennett M. Topiramate augmentation in treatment-resistant obsessive-compulsive disorder: A retrospective, open-label case series. Depress. Anxiety 2006; 23: 1-5.
Lafleur DL, Pittenger C, Kelmendi B et al. N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder. Psychopharmacology (Berl) 2006; 184: 254-256.
Storch EA, Merlo LJ, Bengtson M et al. D-cycloserine does not enhance exposure-response prevention therapy in obsessive-compulsive disorder. Int. Clin. Psychopharmacol. 2007; 22: 230-237.
Kushner MG, Kim SW, Donahue C et al. D-cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol. Psychiatry 2007; 62: 835-838.
Wilhelm S, Buhlmann U, Tolin DF et al. Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive disorder. Am. J. Psychiatry 2008; 165: 335-341.
Winslow J, Insel T. Neurobiology of obsessive compulsive disorder: A possible role for serotonin. J. Clin. Psychiatry 1990; 51: 27-31 discussion 55.
Barr LC, Goodman WK, Price LH, McDougle CJ. The serotonin hypothesis of obsessive compulsive disorder: Implications of pharmacologic challenge studies. J. Clin. Psychiatry 1992; 53 Suppl: 17-28.
Goddard AW, Shekhar A, Whiteman AF, McDougle CJ. Serotoninergic mechanisms in the treatment of obsessive-compulsive disorder. Drug Discov. Today 2008; 13: 325-332.
Denys D, Zohar J, Westenberg H. The role of dopamine in obsessive-compulsive disorder: Preclinical and clinical evidence. J. Clin. Psychiatry 2004; 65: 11-17.
Harsányi A, Csigó K, Demeter G, Nemeth A. New approach to obsessive-compulsive disorder: Dopaminergic theories. Psychiatria Hungarica: A Magyar Pszichiatriai Tarsasag Tudomanyos Folyoirata 2007; 22: 248-258.
Yu X-C, Wu B-L, Gao J-C, Yang W. Theanine enhanced both the toxicity of strychnine and anticonvulsion of pentobarbital sodium. Drug Chem. Toxicol. 2016; 39: 217-223.
Javaid A, Bonkovsky HL. Hepatotoxicity due to extracts of Chinese green tea (Camellia sinensis): A growing concern. J. Hepatol. 2006; 45: 334-336.
Jimenez-Saenz M, Martinez-Sanchez MC. Acute hepatitis associated with the use of green tea infusions. J. Hepatol. 2006; 44: 616-617.
Mazzanti G, Di Sotto A, Vitalone A. Hepatotoxicity of green tea: An update. Arch. Toxicol. 2015; 89: 1175-1191.
Teschke R, Zhang L, Melzer L, Schulze J, Eickhoff A. Green tea extract and the risk of drug-induced liver injury. Expert Opin. Drug Metab. Toxicol. 2014; 10: 1663-1676.
Wang D, Meng J, Xu K et al. Evaluation of oral subchronic toxicity of Pu-erh green tea (camellia sinensis var. assamica) extract in Sprague Dawley rats. J. Ethnopharmacol. 2012; 142: 836-844.
Wu K-M, Yao J, Boring D. Green tea extract-induced lethal toxicity in fasted but not in nonfasted dogs. Int. J. Toxicol. 2011; 30: 19-20.

Auteurs

Mehran Nematizadeh (M)

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Hossein Ghorbanzadeh (H)

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Hossein Sanjari Moghaddam (HS)

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Mohammadreza Shalbafan (M)

Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Mahsa Boroon (M)

Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Amir-Abbas Keshavarz-Akhlaghi (AA)

Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Shahin Akhondzadeh (S)

Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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