Inhibitor-Free Variant of the Cheung Regimen: Successful Adjunctive Therapy in Long-Standing Hypochondriasis With Prominent Somatic Features

Abstract

Hypochondriacal obsessive-compulsive disorder (OCD) combines intrusive health anxieties with compulsive reassurance seeking and often resists high-dose selective serotonin reuptake inhibitors and cognitive-behavioural therapy. Interest has shifted toward glutamatergic agents that mimic ketamine's rapid synaptic effects. A 34-year-old woman endured two years of recurrent fear of serious gastrointestinal and cardiac disease. Escitalopram, later switched to fluoxetine, plus intermittent low-dose atypical antipsychotics and benzodiazepines, produced only partial relief. No psychotic features emerged, yet nightly rumination and repeated medical visits persisted. She agreed to add dextromethorphan 30 mg once daily together with piracetam 600 mg once daily. She declined a cytochrome P450 2D6 (CYP2D6)-inhibiting antidepressant, so no pharmacokinetic booster was used. The combination represents a pared-down variant of the Cheung glutamatergic regimen. Within three weeks, the patient reported the disappearance of nocturnal anxiety, cessation of gastrointestinal preoccupations, and overall mood normalisation; only mild sleep disruption occurred, and no other adverse effects surfaced. Even without CYP2D6 inhibition, the pairing of low-dose dextromethorphan (N-methyl-D-aspartate antagonism) and piracetam (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid potentiation) may trigger enough neuroplastic change to quiet refractory hypochondriacal OCD. Although confounded by ongoing medications, recent changes to the background regimen, and the absence of CYP2D6 genotyping or structured OCD ratings, this single observation encourages further controlled study of low-risk glutamatergic augmentation for anxiety-spectrum disorders that defy conventional care.