Lamotrigine Augmentation of Serotonin Reuptake Inhibitors in Severe and Long-Term Treatment-Resistant Obsessive-Compulsive Disorder

Abstract

The treatment recommendations in obsessive-compulsive disorder (OCD) after lack of response to selective serotonin reuptake inhibitors (SSRIs) include augmentation with other drugs, particularly clomipramine, a more potent serotonin reuptake inhibitor (SRI), or antipsychotics. We present two cases of response to lamotrigine augmentation in treatment-refractory OCD; each received multiple SRI trials over a >10-year period. The first patient had eleven years of treatment with multiple combinations including clomipramine and SSRIs. She had a >50% decrease of Y-BOCS (from 29 to 14) by augmenting paroxetine (60 mg/day) with lamotrigine (100 mg/day). The second patient had 22 years of treatment with multiple combinations, including combinations of SSRIs with clomipramine and risperidone. She had an almost 50% decrease of Y-BOCS (from 30 to 16) and disappearance of tics by augmenting clomipramine (225 mg/d) with lamotrigine (200 mg/day). These two patients were characterized by lack of response to multiple treatments, making a placebo response to lamotrigine augmentation unlikely. Prospective randomized trials in treatment-resistant OCD patients who do not respond to combinations of SSRIs with clomipramine and/or antipsychotics are needed, including augmentation with lamotrigine. Until these trials are available, our cases suggest that clinicians may consider lamotrigine augmentation in such treatment-resistant OCD patients.

Hoarding Symptoms Respond to Treatment for Rapid Cycling Bipolar II Disorder

“…[16][17][18][19][20] In addition, in at least 1 previous case series, it was reported that some patients with hoarding disorder responded to extended-release methylphenidate. 21 Thus, our report suggests that the treatment of bipolar depression, when present, may help patients with different types of obsessivecompulsive and related disorder symptoms, including hoarding.…”

Lamotrigine Uses in Psychiatric Practice

“…Arrojo-Romero et al 25 reported on successful LAM augmentation of SSRIs in 2 severe and long-term treatment-resistant OCDs.…”

Avances en el tratamiento farmacológico del trastorno obsesivo-compulsivo.

“…La lamotrigina ha mostrado eficacia al agregarse a un ISRS en pacientes resistentes de acuerdo a dos EADCCP (36,37), a un trabajo retrospectivo (38) y a reportes de casos (39,40). Asimismo, la adición de pregabalina es útil en pacientes con TOC resistente a la combinación de ISRS y antipsicóticos atípicos de acuerdo a un estudio abierto (41).…”