scholarly journals Agomelatine Augmentation of Escitalopram Therapy in Treatment-Resistant Obsessive-Compulsive Disorder: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Domenico De Berardis ◽  
Nicola Serroni ◽  
Stefano Marini ◽  
Giovanni Martinotti ◽  
Francesca Ferri ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Chronic Condition ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
Young Female ◽  
Treatment Resistant ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Augmentation Strategies

Obsessive-compulsive disorder (OCD) is a chronic condition characterized by obsessions or compulsions that cause distress or interfere with functioning. Selective serotonin reuptake inhibitors are the first-line strategy in the treatment of OCD, but approximately 40% to 60% of patients with OCD fail to respond to them. Several augmentation strategies have been proposed, including the use of atypical antipsychotics and antidepressant combinations. In the present paper we describe the case of a young female patient suffering from severe treatment-resistant OCD who remitted as a result of agomelatine augmentation of escitalopram therapy.

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

CNS Spectrums ◽  
2006 ◽  
Vol 11 (11) ◽  
pp. 879-883 ◽  
Author(s):  
Bernardo Dell'Osso ◽  
Emanuela Mundo ◽  
A. Carlo Altamura
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Case Series ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

ABSTRACTObsessive-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.

Treatments for Obsessive-Compulsive Disorder

2015 ◽  
Author(s):  
Darin D. Dougherty ◽  
Scott L. Rauch ◽  
Michael A. Jenike
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Behavior Therapy ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
First Line Therapy ◽  
Line Therapy ◽  
Augmentation Strategies ◽  
Overwhelming Evidence ◽  
Limited Support

There is overwhelming evidence of the most rigorous type supporting the efficacy of serotonin reuptake inhibitors (SRIs) in the treatment of obsessive-compulsive disorder (OCD). Along with SRIs, behavior therapy must be considered a viable first-line therapy. The best available data suggest that behavior therapy, and perhaps cognitive therapy, is at least as effective as medication in some instances and may be superior with respect to risks, costs, and enduring benefits. A variety of second-line medication treatments for OCD have been studied in a controlled or systematic fashion. Augmentation of SRIs with antipsychotics, buspirone, or clonazepam is provisionally recommended based on the available data. Other monotherapies and augmentation strategies find very limited support at present.

scholarly journals Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

CNS Spectrums ◽  
2005 ◽  
Vol 10 (12) ◽  
pp. 966-979,983 ◽  
Author(s):  
Bernardo Dell'Osso ◽  
Alfredo Carlo Altamura ◽  
Andrea Allen ◽  
Eric Hollander
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Symptom Improvement ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Future Directions ◽  
Compulsive Disorder ◽  
Behavioral Treatments ◽  
Deep Brain

AbstractRecent studies on the epidemiology of obsessive-compulsive disorder (OCD) estimate 50 million patients suffer from OCD worldwide, thus making it a global problem. The treatment of OCD has changed substantially over the last 2 decades following the introduction of selective serotonin reuptake inhibitors, which provide symptom improvement in ~60% of patients. However, some patients remain resistant to the standard pharmacologic and behavioral treatments. Although some treatment-resistant patients respond to pharmacologic augmentations, others do not, and there is evidence that some of the most severe cases benefit from treatment with neurosurgical interventions. Besides pharmacologic, behavioral, and neurosurgical approaches, different brain stimulation methods—transcranial magnetic stimulation, deep brain stimulation, and electroconvulsive therapy—have been investigated in treatment-resistant patients with OCD. However, available data about the use of these techniques in OCD treatment are quite limited in terms of sample size and study design, given the difficulty in conducting standard blinded trials for these procedures. In addition, none of the mentioned treatments have received Food and Drug Administration approval for the treatment of OCD. Nevertheless, promising findings regarding efficacy, tolerability, and non-invasiveness and/or reversibility of these techniques have increased interest in investigating their use in treatment-resistant OCD.

scholarly journals Pharmacotherapy for obsessive—compulsive disorder

2011 ◽  
Vol 17 (6) ◽  
pp. 419-434 ◽  
Author(s):  
Naomi Fineberg ◽  
Angus Brown
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Pharmacological Treatment ◽  
Special Populations ◽  
Evidence Based ◽  
First Line ◽  
Obsessive Compulsive ◽  
Evidence Based Treatment ◽  
Compulsive Disorder ◽  
Augmentation Strategies ◽  
Treatment Refractory

SummaryWe present a narrative review of evidence-based treatment for obsessive–compulsive disorder (OCD), covering first-line pharmacological treatment, augmentation strategies, approaches for treatment-refractory OCD and the management of OCD in special populations (children and adolescents, pregnant and breast-feeding women, and elderly people).

scholarly journals On the Pharmacotherapy of Obsessive—Compulsive Disorder: Is a Consensus Possible?

2000 ◽  
Vol 45 (3) ◽  
pp. 257-262 ◽  
Author(s):  
Christo Todorov ◽  
Mark H Freeston ◽  
Francois Borgeat
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Research Evidence ◽  
Serotonin Reuptake Inhibitors ◽  
Expert Consensus ◽  
Consensus Guidelines ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Objective: To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive–compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials. Method: The literature on the pharmacotherapy of OCD was critically examined. Results: The available research evidence is not conclusive but suggests that clomipramine possesses greater antiobsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs. Conclusion: Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.

Obsessive–Compulsive Disorder

2014 ◽  
Vol 27 (2) ◽  
pp. 116-130 ◽  
Author(s):  
Gyula Bokor ◽  
Peter D. Anderson
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
Package Insert ◽  
Repetitive Behaviors ◽  
Anterior Cingulate ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Mental Acts ◽  
The Brain

Obsessive–compulsive disorder (OCD) is a common heterogeneous psychiatric disorder manifesting with obsessions and compulsions. Obsessions are intrusive, recurrent, and persistent unwanted thoughts. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to the obsessions. The heterogeneity of OCD includes themes of obsessions, types of rituals, presence or absence of tics, etiology, genetics, and response to pharmacotherapy. Complications of OCD include interpersonal difficulties, unemployment, substance abuse, criminal justice issues, and physical injuries. Areas of the brain involved in the pathophysiology include the orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia. Overall, OCD may be due to a malfunction in the cortico–striato–thalamo–cortical circuit in the brain. Neurotransmitters implicated in OCD include serotonin, dopamine, and glutamate. Numerous drugs such as atypical antipsychotics and dopaminergic agents can cause or exacerbate OCD symptoms. The etiology includes genetics and neurological insults. Treatment of OCD includes psychotherapy, pharmacotherapy, electroconvulsive therapy, transcranial magnetic simulation, and in extreme cases surgery. Exposure and response prevention is the most effective form of psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy. Higher doses than listed in the package insert and a longer trial are often needed for SSRIs than compared to other psychiatric disorders. Alternatives to SSRIs include clomipramine and serotonin/norepinephrine reuptake inhibitors. Treatment of resistant cases includes augmentation with atypical antipsychotics, pindolol, buspirone, and glutamate-blocking agents.

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