Augmentation of Serotonin Reuptake Inhibitors in Refractory Obsessive-Compulsive Disorder Using Adjunctive Olanzapine

Bystritsky, Alexander; Ackerman, Deborah L.; Rosen, Richard; Vapnik, Tanya; Gorbis, Eda; Maidment, Karron M.; Saxena, Sanjaya

doi:10.4088/jcp.v65n0418

Cited by 171 publications

(114 citation statements)

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“…41,43,45 Two studies involving 70 subjects (evenly divided between treatment arms) contributed to the olanzapine strata. 38,46 Three studies involving 102 subjects (evenly divided between treatment arms) contributed to the quetiapine strata. 39,40,42 Haloperidol (ARD in proportion of treatment responders = 0.29 (95% CI: 0.07, 0.52) and risperidone (ARD = 0.33 (95% CI: 0.14, 0.51)) demonstrated significant efficacy as compared to placebo.…”

Section: Resultsmentioning

confidence: 99%

“…[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.…”

Section: Included Studiesmentioning

confidence: 99%

“…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).…”

Section: Included Studiesmentioning

confidence: 99%

“…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.…”

Section: Included Studiesmentioning

confidence: 99%

“…Four of the remaining studies reported no significant change in HAM-D ratings in the antipsychotic augmentation versus placebo groups, although no data were available from these studies. 38,41,43,44 The remaining studies did not report HAM-D as an outcome measure. 39,42,46 No meta-analysis was performed on the available data as the missing data were not missing at random, that is, there was a bias toward presenting actual numeric data for changes in HAM-D score within individual studies when these results were significant.…”

Section: Proportion Of Treatment Responders and Comorbid Depression Smentioning

confidence: 99%

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

Bloch

Landeros-Weisenberger

et al. 2006

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As many as half of obsessive-compulsive disorder (OCD) patients treated with an adequate trial of serotonin reuptake inhibitors (SRIs) fail to fully respond to treatment and continue to exhibit significant symptoms. Many studies have assessed the effectiveness of antipsychotic augmentation in SRI-refractory OCD. In this systematic review, we evaluate the efficacy of antipsychotic augmentation in treatment-refractory OCD. The electronic databases of PubMed, PsychINFO (1967PsychINFO ( -2005, Embase (1974Embase ( -2000 and the Cochrane Central Register of Controlled Trials (CENTRAL, as of 2005, Issue 3) were searched for relevant double-blind trials using keywords 'antipsychotic agents' or 'neuroleptics' and 'obsessive-compulsive disorder'. Search results and analysis were limited to double-blind, randomized control trials involving the adult population. The proportion of subjects designated as treatment responders was defined by a greater than 35% reduction in Yale Brown Obsessive-Compulsive Scale (Y-BOCS) rating during the course of augmentation therapy. Nine studies involving 278 participants were included in the analysis. The meta-analysis of these studies demonstrated a significant absolute risk difference (ARD) in favor of antipsychotic augmentation of 0.22 (95% confidence interval (CI): 0.13, 0.31). The subgroup of OCD patients with comorbid tics have a particularly beneficial response to this intervention, ARD = 0.43 (95% CI: 0.19, 0.68). There was also evidence suggesting OCD patients should be treated with at least 3 months of maximaltolerated therapy of an SRI before initiating antipsychotic augmentation owing to the high rate of treatment response to continued SRI monotherapy (25.6%). Antipsychotic augmentation in SRI-refractory OCD is indicated in patients who have been treated for at least 3 months of maximal-tolerated therapy of an SRI. Unfortunately, only one-third of treatment-refractory OCD patients show a meaningful treatment response to antipsychotic augmentation. There is sufficient evidence in the published literature, demonstrating the efficacy of haloperidol and risperidone, and evidence regarding the efficacy of quetiapine and olanzapine is inconclusive. Patients with comorbid tics are likely to have a differential benefit to antipsychotic augmentation.

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Section: Resultsmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Proportion Of Treatment Responders and Comorbid Depression Smentioning

confidence: 99%

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

Bloch

Landeros-Weisenberger

et al. 2006

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Efficacy and Comparative Effectiveness of Atypical Antipsychotic Medications for Off-Label Uses in Adults

Maher¹,

Maglione²,

Bagley³

et al. 2011

JAMA

517

400

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Benefits and harms vary among atypical antipsychotic medications for off-label use. For global behavioral symptom scores associated with dementia in elderly patients, small but statistically significant benefits were observed for aripiprazole, olanzapine, and risperidone. Quetiapine was associated with benefits in the treatment of generalized anxiety disorder, and risperidone was associated with benefits in the treatment of obsessive-compulsive disorder; however, adverse events were common.

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Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders

Ipser

Carey

Dhansay

et al. 2006

Cochrane Database of Systematic Reviews

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Augmentation of Serotonin Reuptake Inhibitors in Refractory Obsessive-Compulsive Disorder Using Adjunctive Olanzapine

Cited by 171 publications

References 0 publications

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

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

Efficacy and Comparative Effectiveness of Atypical Antipsychotic Medications for Off-Label Uses in Adults

Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders

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