Adding quetiapine to SRI in treatment-resistant obsessive???compulsive disorder: a randomized controlled treatment study

Abstract

This study aimed to determine the efficacy and tolerability of adding quetiapine to a serotonin reuptake inhibitor in treatment-resistant obsessive-compulsive disorder (OCD). Twenty-one adult treatment-resistant OCD patients were randomized to 16 weeks of augmentation with either quetiapine (n = 11) or placebo (n = 10). Patients with significant comorbidities, including tic-spectrum disorders, were not included. The treatment was well tolerated, with only one premature dropout in each treatment-group. The primary analysis showed that individuals in the quetiapine-treated group showed a 14% mean improvement in baseline Yale-Brown Obsessive-Compulsive Scale scores at study endpoint compared with a 6% improvement in those treated with placebo, but this difference did not reach statistical significance (F<1). Three patients treated with quetiapine met criteria for clinical response, compared to one patient who was treated with placebo. Larger studies are needed to explore the efficacy of second generation antipsychotics, such as quetiapine, when used as adjunct treatment in resistant OCD.

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder

“…[38][39][40][41][42][43][44][45][46] All studies used Y-BOCS ratings as the primary measure of OCD symptom severity and defined treatment response as the primary outcome measure. Four of these nine studies used a greater than 35% reduction in Y-BOCS score as their criteria for treatment response.…”

“…40,41,44,45 Five of these studies used a greater than 25% reduction in Y-BOCS score as their criteria for treatment response. 37,38,41,42,45 Through a combination of personal communications with the authors 37,41,42 and available manuscript data, 39,46 the number of responders at the 35% reduction threshold was available for all these trials. Seven of the nine traditional antipsychotic augmentation versus placebo studies tested HAM-D ratings for depression, whereas two used the Montgomery-Asberg Depression Ratings Scale (MADRS).…”

“…Seven of the nine traditional antipsychotic augmentation versus placebo studies tested HAM-D ratings for depression, whereas two used the Montgomery-Asberg Depression Ratings Scale (MADRS). 39,42 Seven of these nine studies examined antipsychotic augmentation in OCD subjects who had failed at least 12 weeks of SRI monotherapy on a single agent or 16 weeks on a combination of two agents SRI. Two studies examined antipsychotic augmentation in OCD patients who had failed SRI monotherapy at maximal doses of less than 12 weeks duration.…”

“…Two studies examined antipsychotic augmentation in OCD patients who had failed SRI monotherapy at maximal doses of less than 12 weeks duration. 39,46 The range of follow-up interval after initiation of antipsychotic augmentation ranged from 4 weeks 44 to 16 weeks, 42 with the majority of studies settling on 6 or 8 weeks. Five studies included OCD patients with comorbid tic disorders.…”

“…39,[43][44][45][46] Five of the nine studies were primarily industry funded. [38][39][40]42,43 A full description of the nine included studies in this review are available in Table 1. CGI = Clinical Global Impression Scale; OCD = obsessive-compulsive disorder; SRI = serotonin reuptake inhibitor.…”