Optimized Oral Glutamatergic Augmentation in Refractory Home-Dominant Contamination Obsessive-Compulsive Disorder With Somatic, Affective, and Motivational Features: A Case Report of Incremental Functional Gains.
Cureus June 1, 2026 Hoi Ki Cheung, Ngo Cheung
A 26-year-old woman with severe contamination-focused obsessive-compulsive disorder (OCD) that persisted despite standard treatments showed meaningful improvement after a glutamatergic augmentation strategy using dextromethorphan, piracetam, and L-glutamine, combined with CYP2D6-inhibiting antidepressants. Over nine months, bathing time decreased from about 1.5 hours to about 30 minutes, and ritual preoccupation reduced by 20-30%. Mood, energy, motivation, and daily functioning improved, and passive suicidal ideation resolved temporarily. Residual cleaning symptoms remained at home. The case is hypothesis-generating and not evidence of regimen-specific efficacy; larger controlled studies are needed.