TABLE 4

Roadmap for potential psychopharmacological interventions in OCD

Strategy of InterventionExample of Neurobiological TargetTherapeutic ObjectiveHypothesized Mechanism for Therapeutic Effect in OCDSection
Enhance infrastructure
Monoamine neurotransmitter systemsTo optimize the balance in 5-HT, dopamine, and norepinephrine neurotransmissionFacilitation of SMS shifts from arousal to satietyV.B.1
Circadian rhythmicityTo maximize entrainment and synchrony of oscillatory processesReliance of SMS on well coordinated circadian processesV.B.2
NAD metabolismTo optimize a wide range of cellular functionsReliance of SMS on efficient cellular functioningV.B.3
Facilitate relearning
SMS module for Appraisal of Potential DangerTo facilitate relearning of appraisal of potential dangerAugmentation of neural plasticity to aid recalibration of SMSV.C
SMS output modulesTo facilitate relearning of behavioral response repertoireAugmentation of neural plasticity and provision of enhanced affective cues for SMS shut downV.C
Fix a weak link
5-HT signaling via 5-HT2C receptorsTo restore negative feedback yedasentience signaling that shuts down SMSIncrease of serotonergic-mediated satietyV.D.2.a
SMS-neuroimmune communicationTo use microglia “off” signaling molecules to shut down SMSSMS negative feedback pathways employ same transmitters as microglia “off” signalsV.D.2.b