Augmentation strategies in obsessive–compulsive disorder. (February 2013)

• Record Type: Journal Article
• Authors: Arumugham, Shyam Sundar; Reddy, Janardhan YC
• Is Part Of: Expert review of neurotherapeutics. Volume 13:(2013)Supplement 2
• Page Start: 187
• Page End: 203
• Publication Date: 2013-02
• Subjects: antidepressants -- antipsychotics -- augmentation -- cognitive-behavior therapy -- glutamate antagonists -- obsessive–compulsive disorder -- repetitive transcranial magnetic stimulation -- SSRI -- treatment-resistant -- psychosurgery; Neuropharmacology -- Periodicals; 615.7805
• DOI: 10.1586/ern.12.160
• Languages: English
• ISSNs: 1473-7175

Abstract

Around 40–60% of patients with obsessive–compulsive disorder do not show adequate response to selective serotonin reuptake inhibitors (SSRIs). Augmentation strategies are recommended in people who show partial response to SSRI treatment or poor response to multiple SSRIs. In this article, the authors review the evidence for augmentation strategies. The available evidence is predominantly based on small-scale, randomized controlled trials, open-label trials and case series. Antipsychotic augmentation, especially risperidone, haloperidol, aripiprazole and cognitive-behavior therapy have shown the best evidence. Ondansetron, memantine, riluzole, clomipramine, mirtazapine and repetitive transcranial magnetic stimulation over supplementary motor area show some preliminary evidence. Ablative neurosurgery or deep brain stimulation may be tried in carefully selected treatment refractory patients.