Marked Improvement in Treatment-Intolerant Obsessive-Compulsive Disorder in an Adolescent Using a Glutamatergic Regimen With Dextromethorphan, Piracetam, and Goldenseal Root

A 16-year-old boy with severe obsessive-compulsive disorder (OCD), characterized by health-focused obsessions, intrusive ruminations, derealization, and significant functional impairment, failed to tolerate standard serotonergic agents (escitalopram, fluoxetine) and bupropion due to worsening anxiety, somatic concerns, or headaches. An oral glutamatergic regimen was initiated with dextromethorphan 30 mg/day for N-methyl-D-aspartate (NMDA) antagonism, piracetam 1,200 mg/day for AMPA modulation, and goldenseal (Hydrastis canadensis) root extract 600 mg/day as a botanical CYP2D6 inhibitor to prolong dextromethorphan exposure, alongside low-dose pregabalin, risperidone, and aripiprazole for ancillary support. Within four weeks of adding goldenseal, symptoms markedly improved, meeting remission thresholds: the Patient Health Questionnaire-9 (PHQ-9) score fell to 2, GAD-7 score to 3, obsessive thoughts and derealization resolved, headaches ceased, and full school attendance and functioning returned. These benefits lasted for two months, and there were no negative effects from goldenseal. This case indicates that a cost-effective, entirely oral amalgamation of a prevalent cough suppressant, a nootropic, and a botanical supplement may yield ketamine-like glutamatergic advantages for patients with OCD who are intolerant to conventional treatments; however, controlled studies are required to validate efficacy and safety.