Enhancing OCD Treatment with Adjunctive Atypical Antipsychotics
OCD is a chronic psychiatric disorder that affects about 2.5% of the population and can be highly debilitating. While serotonin reuptake inhibitors (SRIs) are the most effective pharmacologic treatment currently available, 40% to 60% of patients do not respond adequately to this treatment alone. Dr. Danish is an expert in treating treatment-resistant OCD, and he employs various supplements and medications to augment treatment. In more severe cases, he sometimes adds atypical antipsychotics, which have considerable evidence supporting their efficacy. However, this class of medications comes with unique side effects that need to be considered, and not all atypical antipsychotics are efficacious in OCD. Below, Dr. Danish examines research supporting the use of Seroquel (quetiapine), Abilify (aripiprazole), Risperdal (risperidone), and Zyprexa (olanzapine) in OCD.
Read Dr. Danish’s blog on Tardive Dyskinesia, a rare but permanent side effect some patients get when using this class of medications for a long period of time.
Quetiapine
A study conducted by Denys et al. evaluated the efficacy and tolerability of quetiapine in addition to an SRI for treatment-refractory OCD patients. In this double-blind, placebo-controlled trial, 40 patients were randomly assigned to receive either quetiapine or placebo in addition to their SRI treatment. The results demonstrated a significant decrease in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score in the quetiapine group compared to the placebo group. Specifically, 40% of patients in the quetiapine group were responders, showing a decrease of ≥35% in Y-BOCS score, compared to only 10% in the placebo group. The most common side effects included somnolence, dry mouth, weight gain, and dizziness. These findings suggest that quetiapine can be a beneficial addition for patients who do not respond to SRI treatment alone (source).
Please see the following blog for more detailed information on the pros, cons, and evidence for the off-label use of Seroquel (quetiapine) in OCD.
Aripiprazole
Aripiprazole has also been studied as an augmentative treatment for SSRI-refractory OCD. Talaei et al. conducted a single-blind, randomized study comparing the efficacy of aripiprazole and quetiapine. Patients who did not respond to 12 weeks of SSRI treatment were randomly assigned to receive either aripiprazole or quetiapine for an additional 12 weeks. Both medications were found to be effective and well-tolerated, with significant improvements noted in Y-BOCS scores. Aripiprazole, in particular, showed a more rapid onset of therapeutic response, making it a promising option for augmenting SSRI treatment in OCD patients (source).
Please read this blog on the pros and cons of Abilify (aripiprazole), which is a neuroleptic medication used to treat a variety of disorders, including OCD. It is one of the most commonly prescribed mood stabilizers out there, in all age groups.
Risperidone
Selvi et al. compared the efficacy of risperidone and aripiprazole as augmenting agents in SSRI-refractory OCD patients. In this single-blind, randomized study, patients who did not show a ≥35% decrease in Y-BOCS after 12 weeks of SSRI monotherapy were assigned to receive either risperidone or aripiprazole. The results indicated that risperidone was more effective than aripiprazole, with 72.2% of patients in the risperidone group meeting the response criteria compared to 50% in the aripiprazole group. This suggests that risperidone may be a more effective augmentative treatment for OCD patients who do not respond adequately to SSRIs alone (source).
Risperidone has unique side effects; Please read the attached blog for more information which details dosing and those potential side effects.
Olanzapine
Dar et al. conducted a study comparing the efficacy of aripiprazole, olanzapine, and L-methyl folate in treatment-resistant OCD. Patients who did not respond to 12 weeks of SRI monotherapy were assigned to receive one of these augmentative treatments. The study found significant improvements in Y-BOCS scores in both the olanzapine and aripiprazole groups, while no significant change was observed in the L-methyl folate group. The Clinical Global Impression-Severity (CGI-S) scores also decreased significantly in the olanzapine and aripiprazole groups, indicating that these medications can be effective options for augmenting SRI treatment in resistant OCD (source).
Getting in Touch with Dr. Danish and his Team
At Philadelphia Integrative Psychiatry, we make it a priority to stay on top of the latest research related to OCD treatment so we can provide the best quality care in a safe manner. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for OCD or similar conditions, please text or call 610-999-6414 to learn how we can help.
For more on this topic and related subjects, check out these blogs:
Discover how we treat OCD with a comprehensive approach at Philadelphia Integrative Psychiatry.
Unveil the power of Cognitive Behavioral Therapy in managing and overcoming OCD.
Explore innovative OCD treatments available at Philadelphia Integrative Psychiatry.
Many patients with OCD will require SSRIs or SNRIs be dosed at the high end of the dose range, and, in some cases, even higher than what is listed by the manufacturer.
Follow our guide to seeking OCD treatment for a structured path to recovery.
Understand inflammation's role in tic disorders and OCD through our latest blog.
Learn about the nuances of social and relationship OCD and effective ways to manage it.
Consider Pregabalin as an augmentation strategy for treatment-resistant OCD.
Discover the benefits of N-acetylcysteine (NAC) as a supplement for OCD.
Learn about Inositol for OCD and its potential benefits in our latest post.
Understand the application of Memantine in treating OCD symptoms effectively.
Luvox (fluvoxamine) is a SSRi that is FDA approved to treat OCD.
Sources:
