Psycho-Babble Medication Thread 688149

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Memantine/Namenda CBT question

Posted by chess on September 22, 2006, at 10:41:17

i have ocd, pure-o type, and i take lexapro for it, but my anxiety and ocd are still high, my doc has offered to add memantine to the lexapro,
but first i've done some research about the use of medications for anxiety that affect glutamate, and I've learned that the fearful memories or "fear memory responses" we OCDers have that are tormenting us are not re-wired or destroyed with therapy and meds BUT rather new "healthy memories" are made that over-ride the older "fear memory responses" and it's by doing CBT-ERP that we form these "new healthy memory responses". I came across this while surfing the web, "The use of partial AGONISTS (like d-cycloserine) at the NMDA receptor for acute augmentation of the emotional learning within psychotherapy represents a novel and potentially very powerful new therapeutic tool. Glutamate receptors clearly serve to mediate the learning events that take place during the acquisition of fear. Recognition that treatment of anxiety disorders also includes new emotional learning in the form of extinction that may be facilitated with augmentation at the NMDA receptor, provides for an exciting set of opportunities for the treatment of these often refractory disorders." This explains why d-cycloserine may help with OCD therapy because it's an NMDA-receptor AGONIST and thus would assist with the formation of new healthy memory responses and therefore extinction.

But memantine (Namenda) is a NMDA-receptor ANTAGONIST, so then wouldn't it actually interfere with the formation of new "healthy memory responses" and thus interfere with extinction?

 

Re: Memantine/Namenda CBT question

Posted by chess on September 23, 2006, at 20:41:04

In reply to Memantine/Namenda CBT question, posted by chess on September 22, 2006, at 10:41:17

I think I have a good guess about it.
Memantine only kicks in when there's an excessive amount of glutamate activity, so maybe "excessive" glutamate activity interferes with learning as much as "insufficient" glutamate activity interferes with learning (remember d-cycloserine is an glutamate receptor agonist), and thus memantine allows for normal glutamate activity and the normal learning that leads to extinction.

 

Re: Memantine/Namenda CBT question

Posted by Questionmark on September 24, 2006, at 18:22:39

In reply to Memantine/Namenda CBT question, posted by chess on September 22, 2006, at 10:41:17

I'm not sure but I think that partial agonists (like cycloserine is at NMDA Rs) can ultimately have a greater antagonistic than agonistic effect. I could be wrong though. Darn it. Now I need to know.
Anyone?


> i have ocd, pure-o type, and i take lexapro for it, but my anxiety and ocd are still high, my doc has offered to add memantine to the lexapro,
> but first i've done some research about the use of medications for anxiety that affect glutamate, and I've learned that the fearful memories or "fear memory responses" we OCDers have that are tormenting us are not re-wired or destroyed with therapy and meds BUT rather new "healthy memories" are made that over-ride the older "fear memory responses" and it's by doing CBT-ERP that we form these "new healthy memory responses". I came across this while surfing the web, "The use of partial AGONISTS (like d-cycloserine) at the NMDA receptor for acute augmentation of the emotional learning within psychotherapy represents a novel and potentially very powerful new therapeutic tool. Glutamate receptors clearly serve to mediate the learning events that take place during the acquisition of fear. Recognition that treatment of anxiety disorders also includes new emotional learning in the form of extinction that may be facilitated with augmentation at the NMDA receptor, provides for an exciting set of opportunities for the treatment of these often refractory disorders." This explains why d-cycloserine may help with OCD therapy because it's an NMDA-receptor AGONIST and thus would assist with the formation of new healthy memory responses and therefore extinction.
>
> But memantine (Namenda) is a NMDA-receptor ANTAGONIST, so then wouldn't it actually interfere with the formation of new "healthy memory responses" and thus interfere with extinction?
>


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