Atypical Antipsychotics in SSRI Treatment Refractory OCD
Atypical Antipsychotics in SSRI Treatment Refractory OCD
In summary, we found limited evidence for low dose risperidone and aripiprazole in the short-term. Aripiprazole is associated with less risk of weight gain, sedation, and increase in prolactin compared to other antipsychotics. We do not recommend the use of olanzapine or quetiapine to augment SSRIs in OCD. There is some evidence for augmenting a SSRI with CBT or clomipramine before an anti-psychotic. However a combination with clomipramine requires ECG monitoring. The definition of treatment resistance should include at least one adequate trial of CBT. Studies of augmentation of a SSRI with aripiprazole should be followed up in the long-term.
Conclusions
In summary, we found limited evidence for low dose risperidone and aripiprazole in the short-term. Aripiprazole is associated with less risk of weight gain, sedation, and increase in prolactin compared to other antipsychotics. We do not recommend the use of olanzapine or quetiapine to augment SSRIs in OCD. There is some evidence for augmenting a SSRI with CBT or clomipramine before an anti-psychotic. However a combination with clomipramine requires ECG monitoring. The definition of treatment resistance should include at least one adequate trial of CBT. Studies of augmentation of a SSRI with aripiprazole should be followed up in the long-term.
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