A long-term trial of the effectiveness and safety of atypical antipsychotic agents in augmenting SSRI-refractory obsessive-compulsive disorder.

Abstract

OBJECTIVE:

Although atypical antipsychotic agents have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short-term trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term.

METHOD:

Subjects (N = 46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued on SSRI monotherapy plus cognitive-behavioral therapy (CBT) for 1 year. Subjects (N = 44) who failed to respond to SSRIs were randomly assigned to 1 of 3 atypical antipsychotics -- olanzapine, quetiapine, or risperidone -- and were consecutively treated using SSRI + atypical antipsychotics combined with CBT for 1 year. This study was conducted from January 2006 to November 2007 at Osaka City University Graduate School of Medicine Hospital, Japan.

RESULTS:

Augmentation with atypical antipsychotics reduced mean +/- SD Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores in SSRI-refractory OCD patients (at initial assessment = 29.3 +/- 9.9, after 1 year = 19.3 +/- 6.8). However, compared to SSRI responders (at initial assessment = 25.8 +/- 11.4, after 1 year = 13.7 +/- 4.6), total YBOCS scores in those who required atypical antipsychotic augmentation were initially higher, and they remained at higher levels than those of SRI responders after 1 year of the treatments.

CONCLUSIONS:

Our work does not sufficiently support the long-term effectiveness of the atypical antipsychotics in the augmentation of SSRIs for treatment-resistant OCD patients. Even though this approach seems useful for some types of OCD patients, such as those with symmetry/ordering and hoarding symptoms, these data emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, and their chronic use raises a number of safety concerns.

TRIAL REGISTRATION:

(ClinicalTrials.gov) Identifier NCT00854919.

• Authors: Hisato Matsunaga, Toshihiko Nagata, Kazuhisa Hayashida, Kenzo Ohya, Nobuo Kiriike, Dan J Stein
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 70 Issue 6 Pg. 863-8 (Jun 2009) ISSN: 1555-2101 [Electronic] United States
• PMID: 19422759 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2009 Physicians Postgraduate Press, Inc.

Chemical References

• Antipsychotic Agents
• Dibenzothiazepines
• Serotonin Uptake Inhibitors
• Benzodiazepines
• Quetiapine Fumarate
• Paroxetine
• Risperidone
• Olanzapine
• Fluvoxamine

Topics

• Adult
• Ambulatory Care
• Antipsychotic Agents (administration & dosage, adverse effects)
• Benzodiazepines (administration & dosage, adverse effects)
• Body Mass Index
• Cognitive Behavioral Therapy
• Combined Modality Therapy
• Dibenzothiazepines (administration & dosage, adverse effects)
• Drug Resistance
• Drug Therapy, Combination
• Female
• Fluvoxamine (administration & dosage, adverse effects)
• Follow-Up Studies
• Humans
• Long-Term Care
• Male
• Obsessive-Compulsive Disorder (diagnosis, drug therapy, psychology)
• Olanzapine
• Paroxetine (administration & dosage, adverse effects)
• Quetiapine Fumarate
• Risperidone (administration & dosage, adverse effects)
• Selective Serotonin Reuptake Inhibitors (administration & dosage, adverse effects)
• Treatment Outcome
• Young Adult