Review article
The role of the glutamatergic system in the pathogenesis and treatment of obsessive-compulsive disorder

Previous pathogenetic concepts of obsessive-compulsive disorder (OCD) focused mainly on serotonergic and dopaminergic systems. In the present paper, some evidence on the role of the glutamatergic system in the pathogenesis of OCD has been presented. The main elements of the glutamatergic system, among others ionotropic and metabotropic receptors as well as transporters for excitatory neurotransmitters, have been discussed. Molecular-genetic studies suggest an association between the glutamate transporter gene and predisposition to the illness. It has been demonstrated that the glutamatergic system may exert immunomodulatory action what corresponds to immunological concepts of OCD. In recent years, a neurobiological model of OCD has been described postulating a role of the glutamatergic system in the pathogenesis of the illness in the context of relevant neuronal circuits and the cytotoxic effect of glutamate. Finally, possibilities of using drugs influencing the glutamatergic system such as memantine, D-cycloserine, N-acetylcysteine, riluzole, topiramate and lamotrigine in the treatment of patients with OCD have been presented.