Quetiapine augmentation in patients with treatment resistant obsessive???compulsive disorder: a single-blind, placebo-controlled study

Abstract

Recently, atypical antipsychotics have been used for the management of the patients with refractory obsessive-compulsive disorder (OCD). The aim of the present study was to evaluate the results of quetiapine augmentation to a serotonin reuptake inhibitor (SRI) in the patients with refractory OCD. Fifty-two patients with OCD according to DSM-IV entered 3 months of an open-label phase treatment with a SRI with or without concomitant adjunctive treatment regimen. Of them, 27 patients were refractory OCD. These patients were randomly divided into two groups, SRI plus quetiapine and SRI plus placebo, for an 8-week single-blind phase. The course of OCD was evaluated by Yale-Brown Obsession-Compulsion (Y-BOCS) and Clinical Global Impression-Severity of Illness and Improvement (CGI-SI and I) Scales every other week for 8 weeks. Of the 14 patients in group I, nine (64.4%) showed significant improvement with 60% or greater improvement on the Y-BOCS and one (7.1%) partial improvement with 30% or greater improvement on the Y-BOCS, whereas no improvement was observed in group II. The addition of quetiapine to ongoing SRI therapy has been found to be effective and well-tolerated approach in patients with refractory OCD.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…In long-term and relapse prevention studies, escitalopram, fluoxetine, paroxetine, sertraline and clomipramine were superior to placebo (see above for references). Within the limits of the acute treatment phase, response to treatment with SSRIs is characteristi- SSRI Pallanti et al 1999 Yes (C1) Addition of an SSRI to clomipramine Ravizza et al 1996 Yes (C1) Adding lithium to clomipramine * Rasmussen 1984 Yes (C1) Addition of buspirone to an* SSRI Jenike et al 1991b;Markovitz et al 1990 Yes (C1) Addition of topiramate to an SSRI Hollander and Dell'Osso, 2006;Van Ameringen et al 2006 Yes (C1) Addition of N-acetylcysteine to an SSRI Lafleur et al 2006 Yes (C2) Addition of atypical antipsychotics Á aripiprazole Á olanzapine, Á perospirone, Á quetiapine, or Á risperidone, to an SSRI or clomipramine Agid and Lerer 1999; Atmaca et al 2002;Bogan et al 2005;Bogetto et al 2000;da Rocha and Correa 2007;Dell'Osso et al 2006;Francobandiera, 2001;Friedman et al 2007b;Kawahara et al 2000;Koran et al 2000;Marazziti and Pallanti 1999;Marazziti et al 2005;Mohr et al 2002;Otsuka et al 2007;Pfanner et al 2000;Ravizza et al 1996;Saxena et al 1996;Stein et al 1997;Storch et al 2008;Weiss et al 1999;Yoshimura et al 2006 Yes (C1) cally partial. Between 30 and 60% cases in acute phase DBPC studies reached a clinically relevant level of improvement.…”

Treatment-refractory obsessive-compulsive disorder: Methodological issues, operational definitions and therapeutic lines

“…Denys et al (2004a) demonstrated in an open-label study that addition of quetiapine (initiated at 75 mg/day and increased to 200 mg/day by week 4) to an SRI for 8 weeks led to a significant decrease in Y-BOCS score in OCD patients previously noted to be treatment-resistant. Atmaca et al (2002) demonstrated in a single-blind, placebo-controlled trial that the addition of quetiapine (50 -200 mg/day dose range, with the majority of patients receiving 75-100 mg/day) to SRI therapy in 14 patients with treatment-resistant OCD led to a significant overall improvement in Y-BOCS scores vs. that of the placebo plus SRI group (n = 13). Clozapine has been studied as monotherapy in a 10-week, open-label, systematic trial involving patients with treatment-resistant OCD, with the authors reporting no significant improvement in symptoms.…”

Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder

“…48,49 The clear efficacy of both typical and atypical antipsychotic agents in Tourette's syndrome 50,51 therefore motivates trials of dopamine antagonists as augmentation therapy in OCD. Indeed, augmentation with typical 52 or atypical antipsychotics [53][54][55][56][57][58][59][60][61] improves symptoms in a substantial fraction of patients whose symptoms are refractory to SRI treatment alone. Early studies suggested that the benefit of antipsychotic medications was most pronounced in patients with OCD and comorbid tics, 52 but more recent studies 53 show benefit in treatment-resistant patients with and without tics.…”