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Treatment of refractory obsessive–compulsive disorder with nutraceuticals (TRON): a 20-week, open label pilot study

Published online by Cambridge University Press:  21 June 2021

Jerome Sarris ,
Gerard J. Byrne ,
Georgina Oliver ,
Lachlan Cribb Open the ORCID record for Lachlan Cribb [Opens in a new window] ,
Scott Blair-West ,
David Castle ,
Olivia M. Dean ,
David A. Camfield ,
Vlasios Brakoulias  and
Chad Bousman
...Show all authors
Jerome Sarris*
Affiliation:
NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
Gerard J. Byrne
Affiliation:
University of Queensland Centre for Clinical Research, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia Mental Health Service, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
Georgina Oliver
Affiliation:
The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
Lachlan Cribb
Affiliation:
The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
Scott Blair-West
Affiliation:
The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
David Castle
Affiliation:
Centre for Complex Interventions, Department of Psychiatry, University of Toronto
Olivia M. Dean
Affiliation:
Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
David A. Camfield
Affiliation:
Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
Vlasios Brakoulias
Affiliation:
Western Sydney Local Health District Mental Health Service, Sydney, New South Wales, Australia School of Medicine, Blacktown Hospital, Translational Health Research Institute (THRI), Clinical and Health Psychology Research Initiative (CaHPRI), Western Sydney University, Sydney, New South Wales, Australia
Chad Bousman
Affiliation:
Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada Department of Physiology & Pharmacology, University of Calgary, Calgary, Alberta, Canada
Nathan Dowling
Affiliation:
The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
Carolyn Ee
Affiliation:
NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
Jenifer Murphy
Affiliation:
The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
Ranjit Menon
Affiliation:
The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
Michael Berk
Affiliation:
Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia Florey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Melbourne, Victoria, Australia
Suneel Chamoli
Affiliation:
University of Queensland Centre for Clinical Research, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
Mark Boschen
Affiliation:
School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
Chee H. Ng
Affiliation:
The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
*
*Author for correspondence: Jerome Sarris, Email: [email protected]
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Abstract

Background

Obsessive–compulsive disorder (OCD) is often challenging to treat and resistant to psychological interventions and prescribed medications. The adjunctive use of nutraceuticals with potential neuromodulatory effects on underpinning pathways such as the glutamatergic and serotonergic systems is one novel approach.

Objective

To assess the effectiveness and safety of a purpose-formulated combination of nutraceuticals in treating OCD: N-acetyl cysteine, L-theanine, zinc, magnesium, pyridoxal-5′ phosphate, and selenium.

Methods

A 20-week open label proof-of-concept study was undertaken involving 28 participants with treatment-resistant DSM-5-diagnosed OCD, during 2017 to 2020. The primary outcome measure was the Yale-Brown Obsessive–Compulsive Scale (YBOCS), administered every 4 weeks.

Results

An intention-to-treat analysis revealed an estimated mean reduction across time (baseline to week-20) on the YBOCS total score of −7.13 (95% confidence interval = −9.24, −5.01), with a mean reduction of −1.21 points per post-baseline visit (P ≤ .001). At 20-weeks, 23% of the participants were considered “responders” (YBOCS ≥35% reduction and “very much” or “much improved” on the Clinical Global Impression-Improvement scale). Statistically significant improvements were also revealed on all secondary outcomes (eg, mood, anxiety, and quality of life). Notably, treatment response on OCD outcome scales (eg, YBOCS) was greatest in those with lower baseline symptom levels, while response was limited in those with relatively more severe OCD.

Conclusions

While this pilot study lacks placebo-control, the significant time effect in this treatment-resistant OCD population is encouraging and suggests potential utility especially for those with lower symptom levels. Our findings need to be confirmed or refuted via a follow-up placebo-controlled study.

Keywords

nutrientsOCDzincvitaminstreatment-resistantN-acetyl cysteine
Type
Review
Information
CNS Spectrums , Volume 27 , Issue 5 , October 2022 , pp. 588 - 597
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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