Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-19T10:35:31.245Z Has data issue: false hasContentIssue false
  • English
  • Français

Quetiapine Augmentation of Selective Serotonin Reuptake Inhibitors in Treatment-Resistant Obsessive-Compulsive Disorder: A Six-Month Follow-Up Case Series

Published online by Cambridge University Press:  07 November 2014

Bernardo Dell'Osso ,
Emanuela Mundo  and
A. Carlo Altamura
Get access Rights & Permissions [Opens in a new window]

Abstract

Obsessive-compulsive disorder (OCD) is a relatively common, often chronic and disabling disorder with high rates of partial and/or absent response to standard, recommended treatments, such as selective serotonin reuptake inhibitors (SSRIs) and psychotherapy. This article presents the cases of four patients suffering from OCD and comorbid mood or anxiety disorders, who were treated with SSRIs at adequate doses for at least 12 weeks, showing a partial response. Quetiapine treatment was added to SSRIs at a dose of 25 mg/day and titrated up to 200 mg/day. Patients were followed up for 6 months. After 12 weeks, all the patients were classified as “much improved” on the Clinical Global Impression–Improvement scale and showed a Yale-Brown Obsessive-Compulsive Scale score reduction ≥35%. After 6 months of follow-up, all the patients maintained the same level of improvement. Although quetiapine augmentation to SSRIs has shown mixed results in published controlled trials in the acute treatment (12 weeks) of patients with treatment-resistant OCD, this case series indicates that patients who benefit from this pharmacologic regimen in the acute phase tend to maintain such an improvement. Larger follow-up studies are warranted to confirm our findings.

Type
Case Report
Information
CNS Spectrums , Volume 11 , Issue 11 , November 2006 , pp. 879 - 883
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Robins, LN, Helzer, JE, Weissman, MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41:949–958.Google Scholar
2. Regier, DA, Farmer, ME, Rae, DS, et al. One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study. Acta Psychiatr Scand. 1993;88:35–47.Google Scholar
3. Pallanti, S, Hollander, E, Bienstock, C, et al, and the International Treatment Refractory OCD Consortium. Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol. 2002;5:181–191.Google Scholar
4. Jenike, MA, Rauch, SL. Managing the patient with treatment-resistant obsessive-compulsive disorder: current strategies. J Clin Psychiatry. 1994;55(suppl):11–17.Google Scholar
5. Greist, JH, Bandelow, B, Hollander, E, et al, and the World Council of Anxiety. WCA recommendations for the long-term treatment of obsessive-compulsive disorder in adults. CNS Spectr. 2003;8(suppl 1):7–16.Google Scholar
6. Denys, D, de Geus, F, van Megen, HJ, Westenberg, HG. A double-blind, randomized, placebo-controlled trial of quetiapine addition in patients with obsessive-compulsive disorder refractory to serotonin reuptake inhibitors. J Clin Psychiatry. 2004;65:1040–1048.Google Scholar
7. Carey, PD, Vythilingum, B, Seedat, S, Muller, JE, van Ameringen, M, Stein, DJ. Quetiapine augmentation of SSRIs in treatment refractory obsessive-compulsive disorder: a double-blind, randomised, placebo-controlled study [ISRCTN83050762]. BMC Psychiatry. 2005;5:5.Google Scholar
8. Fineberg, NA, Sivakumaran, T, Roberts, A, Gale, T. Adding quetiapine to SRI in treatment-resistant obsessive-compulsive disorder: a randomized controlled treatment study. Int Clin Psychopharmacol. 2005;20:223–226.Google Scholar
9. First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV Axis I Disorders: SCID-I Clinician Version. Washington, DC: American Psychiatric Publishing; 1997.Google Scholar
10. Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46:1006–1011.Google Scholar
11. Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale-Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry. 1989;46:1012–1016.Google Scholar
12. Clinical Global Impressions (CGI). In: Guy, W, ed. ECDEU Assessment Manual for Psychopharmacology. US Department of Health, Education, and Welfare Publication (ADM) 76-338. Rockville, Md: National Institute of Mental Health; 1976:218–222.Google Scholar
13. Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.Google Scholar
14. Hamilton, M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–55.Google Scholar
15. Kopala, L, Honer, WG. Risperidone, serotonergic mechanisms and obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry. 1994;151:1714–1715.Google Scholar
16. Leysen, JE. 5-HT2A-receptors: location pharmacological, pathological and physiological role. In: Langer, SZ, Brunello, N, Racagni, G, Mendlewicz, J, eds. Receptor Subtypes: Pharmacologic Significance and Clinical Implication. Basel, Switerzland: Karger; 1992:31–43.Google Scholar
17. Richelson, E. Preclinical pharmacology of antipsychotics drugs: relationship to efficacy and side-effects. J Clin Psychiatry Monograph. 1994;12:13–17.Google Scholar
18. Denys, D, Klompmakers, AA, Westenberg, HG. Synergistic dopamine increase in the rat prefrontal cortex with the combination of quetiapine and fluvoxamine. Psychopharmacology (Berl). 2004;176:195–203.Google Scholar
19. Fernandez Espejo, E. Prefrontocortical dopamine loss in rats delays long-term extinction of contextual conditioned fear, and reduces social interaction without affecting short-term social interaction memory. Neuropsychopharmacology. 2003;28:490–498.Google Scholar
20. Toren, P, Ratner, S, Laor, N, Weizman, A. Benefit-risk assessment of atypical antipsychotics in the treatment of schizophrenia and comorbid disorders in children and adolescents. Drug Saf. 2004;27:1135–1156.Google Scholar