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Therapy-resistant Obsessive-Compulsive Patients Respond to Topiramate: Presented at CPA

By Louise Gagnon

MONTREAL, QUEBEC -- October 19, 2004 -- Topiramate is effective add-on therapy for some patients with obsessive-compulsive disorder (OCD) who have proved resistant to traditional treatment, according to results of an open-series study presented here at the 54^th Canadian Psychiatric Association Annual Meeting.

"A sub-group of patients…responded to the addition of topiramate in their therapy," said Michael Van Ameringen, MD, Principal Investigator and Associate Professor of Psychiatry, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. "We have taken [patients'] OCD from very severe to very minimal by adding topiramate to their therapy. It appears promising."

In 5 men and 11 women with a mean duration of illness of 26.2 years –the researchers added topiramate at a mean dose of 253.1 mg/day to selective serotonin reuptake inhibitor (SSRI) monotherapy or SSRI combination therapy over 14 to 26 weeks. At baseline, the mean Clinical Global Improvement (CGI) score was 6.1, indicating patients were regarded as "severely ill".

By the end of the treatment period, 68.8% had a significant drop in their CGI score. Specifically, 43.8% of subjects had a score of 2, which indicates they were "much improved," and 25% had a score of 1, which indicates they were "very much improved."

Dr. Van Ameringen, who is also Co-director of the Anxiety Disorders Clinic at McMaster University Medical Centre, said that patients with OCD are typically on SSRIs, which produce response rates of 42% to 53%.

Dr. Van Ameringen said his team decided to investigate the role of topiramate therapy in OCD as a result of previous basic science research showing promise in this area.

"Neuroimaging studies found a deficit in the glutamate system in a group of children who had [OCD]," he explained. "That may say something about the neurobiology of the disorder. It made us explore what agents had an effect on glutamate, such as topiramate."


[Presentation title: "Adding Topiramate to an SRI in Treatment-Resistant Obsessive-Compulsive Disorder." Abstract 37]

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