2 replies to this topic

[penisbreath]

Hi,

I was wondering if anyone here was particularly familiar with Memantine and could possibly speculate why, after 4 weeks on the drug, it's been *increasing* my anxiety, agitation, OCD, etc.?

I started on 2.5mg and have titrated in 2.5mg increments every 5-7 days. On lower doses, I noticed a mildish stimulating effect (some jaw clenching, anxiety etc.) which would tend to plateau after about 5 days; there was never a remission from anxiety, however. Once I hit 10mg (5mg b.i.d.), I held off for two weeks, but noticed that the dysphoria, agitation, insomnia etc. were only growing worse, so my psychiatrist suggested I move up to 15mg, which I did exactly a week ago and have only been experiencing the same symptoms.

I know it's a D2 agonist, but I've read it has quite a weak affinity, so is it more likely that the NMDA antagonism itself is having some indirect effect on catecholaminergic activity? And if so, is it reasonable to believe things might settle with time or a higher dose?

To be honest, I've tried just about everything else for my severe OCD (also suffer from comorbid ADD and major depression), so had a lot of hope invested in Memantine and am growing quite desperate. I *do* notice that I'll get this acute, overwhelming sense of mental/physical tranquility for about an hour after I dose (which gives me some hope, I suppose), but that the effect will dissipate quite rapidly.

Unfortunately, there's such a paucity of data, trials, quality subjective reporting and whatnot out there that it's hard to know what to make of any side-effects. I e-mailed two different clinicians who oversaw trials for OCD/GAD and both said that increased anxiety seemed to be quite a rare side-effect (one suggested I raise the dose; the other suggested lowering until I had habituated).

Anyway, if anyone can offer any advice, guidance etc., it would be greatly appreciated! Like I said, I feel so desperate and despairing right now ... Only other thing I'm taking is 0.25mg klonopin at night but I don't notice any effect from it (cut down from 0.5mg three days ago).

[ta5]

I don't know. It's supposed to help. This study just showed up today (from Iran ):

J Psychiatr Res. 2012 Oct 9. pii: S0022-3956(12)00295-6. doi: 10.1016/j.jpsychires.2012.09.015. [Epub ahead of print]

Memantine add-on in moderate to severe obsessive-compulsive disorder: Randomized double-blind placebo-controlled study.

Ghaleiha A, Entezari N, Modabbernia A, Najand B, Askari N, Tabrizi M, Ashrafi M, Hajiaghaee R, Akhondzadeh S.

Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.

There is a growing body of evidence for the efficacy of memantine augmentation in patients with obsessive-compulsive disorder (OCD). However, to date, no double-blind study has addressed this issue. The objective of the present randomized double-blind placebo-controlled study was to evaluate efficacy and tolerability of memantine add-on treatment in patients with moderate to severe OCD. Forty-two patients with the diagnosis of OCD based on DSM-IV-TR who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of ≥21 were randomly assigned to memantine (10 mg/day for the first week, and 20 mg/day for the rest of the trial) or placebo in addition to fluvoxamine for eight weeks. Patients were assessed using Y-BOCS every two weeks. Thirty-eight patients completed the study. Repeated measure ANOVA showed significant effect for time × treatment interaction in total scale [F (2.096, 75.470) = 5.280, P = 0.006] and obsession [F (2.340, 94.547) = 5.716, P = 0.002] and near significant effect for compulsion subscales [F (2.005, 79.179) = 2.841, P = 0.065]. By week eight, all patients in the memantine group and six (32%) patients in the placebo group [P value of Fisher's exact test <0.001] met the criteria for partial and complete response. At the end of the trial, 17 (89%) patients in the memantine group compared with six (32%) patients in the placebo group achieved remission (χ(2)(1) = 13.328, P < 0.001). Frequency of side-effects was not significantly different between the two groups. In summary, we showed that memantine add-on to fluvoxamine significantly improved short-term outcomes in patients with moderate to severe OCD.
PMID: 23063327

→ source (external link)

Edited by ta5, 16 October 2012 - 03:37 PM.

[penisbreath]

Wow, thank you, that's a really useful study -- and about time someone did a double-blind ..

However, it just makes my response more confusing. I've come across two citations in the literature of patients who experienced increased anxiety or mood destabilization which was resolved by lowering the dose; I've also been in e-mail contact with someone who felt worse on 15mg and 20mg, but is doing fine on 10mg a day.

I do have a history of being extremely sensitive to medication, and do recall that the side-effects were less intense on 5mg and 7.5mg, so perhaps I've simply passed my threshold. I'll try e-mail the authors of that study, though, and see if they can offer any advice.