Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review and meta-analysis

BMC Psychiatry. 2014 Nov 29;14:317. doi: 10.1186/s12888-014-0317-5.

Abstract

Background: In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines for Obsessive Compulsive Disorder (OCD) recommended anti-psychotics as a class for SSRI treatment resistant OCD. The article aims to systematically review and conduct a meta-analysis on the clinical effectiveness of atypical anti-psychotics augmenting an SSRI.

Methods: Studies that were double-blind randomized controlled trials of an atypical antipsychotic against a placebo, for a minimum of 4 weeks, in adults with OCD, were included. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. Inclusion criteria included Y-BOCS score of 16 or more and at least one adequate trial of a SSRI or clomipramine for at least 8 weeks prior to randomization. Data sources included Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews (CDSR), trial registries and pharmaceutical databases and manufacturers up to September 2013. Forest-plots were drawn to display differences between drug and placebo on the Y-BOCS.

Results: Two studies found aripiprazole to be effective in the short-term. There was a small effect-size for risperidone or anti-psychotics in general in the short-term. We found no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo.

Conclusions: Risperidone and aripiprazole can be used cautiously at a low dose as an augmentation agent in non-responders to SSRIs and CBT but should be monitored at 4 weeks to determine efficacy.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use*
  • Aripiprazole
  • Benzodiazepines / therapeutic use
  • Clomipramine / therapeutic use
  • Dibenzothiazepines / therapeutic use
  • Double-Blind Method
  • Drug Resistance
  • Drug Therapy, Combination
  • Humans
  • Obsessive-Compulsive Disorder / drug therapy*
  • Olanzapine
  • Piperazines / therapeutic use
  • Quetiapine Fumarate
  • Quinolones / therapeutic use
  • Randomized Controlled Trials as Topic
  • Risperidone / therapeutic use
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Treatment Outcome

Substances

  • Antipsychotic Agents
  • Dibenzothiazepines
  • Piperazines
  • Quinolones
  • Serotonin Uptake Inhibitors
  • Benzodiazepines
  • Quetiapine Fumarate
  • Aripiprazole
  • Risperidone
  • Olanzapine
  • Clomipramine