Possible treatment with Second Generation Antipsychotic as Supplementary Management to Treatment-Resistant Obsessive Compulsive Disorder, a Pilot Study

Introduction: 40%-60% of the patients with obsessive-compulsive disorder remain unimproved by Serotonin-Reuptake inhibitors. The objective of this study was to examine whether addition of the atypical antipsychotic, olanzapine, to serotonin reuptake inhibitor is useful for patients with OCD who do not respond to antidepressant monotherapy. Method: Eleven patients with obsessive compulsive disorder who had not responded to at least 2 previous treatments with a serotonin reuptake inhibitor at maximum dose and duration were assigned to receive olanzapine in addition to antidepressant for 8 weeks in an open-label study. Treatment response was assessed using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Results: six of 11 patients respond to the olanzapine addition. The mean+/-SD baseline YBOCS score of 33.45 +/4.47 dropped to a mean of 25 +/5.98 at endpoint with a mean reduction of 24.56%. Conclusion: Treatment-refractory OCD Patients may benefit from addition of olanzapine to ongoing antidepressant therapy. Introduction Serotonin Reuptake Inhibitors (SRI) is the most effectual drug treatment accessible for obsessive-compulsive disorder (OCD) [1]. Clomipramine, citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline have been proved to be effective against obsessive and compulsive symptoms independent of their antidepressant activity [2-4]. Nevertheless, 50%-60% of patients with OCD fail to respond to a single trial of an SRI, and 20-40% does not respond sufficiently after several medication trials [1]. Moreover, although the selective serotonin reuptake inhibitors (SSRIs) are generally considered to be secure and well tolerated, still a proportion of subjects do experience intolerable side effects and discontinue treatment prematurely. Also, No single drug acting on different neurotransmitter systems has yet proved an absolute efficacy against obsessive-compulsive symptoms. Therapeutic strategies in these resistant cases usually consist of augmentation therapies with, tryptophan, buspirone, clonazepam and lithium or the addition of antipsychotic drugs. But the final results with these tactics were not encouraging so far and have remained somewhat experimental than crucial. The addition of low-dose antipsychotics to standard antidepressant treatment has shown to be effective in some cases, but extrapyramidal side effects have limited the use of typical antipsychotics. Therefore treatment with atypical antipsychotic that shows fewer extrapyramidal symptoms might be a useful alternative for treatment-refractory OCD patients. Beneficial effects of adding risperidone to SSRIs has been observed in some cases of treatment-resistant obsessive-compulsive disorder [5,6]. In prior reports (four open and one double-blind studies) positive results with the addition of olanzapine to the regular antidepressant treatment of the patients [7-11] have been displayed. In the present study a new trial with olanzapine has been performed in a non-western patient population with treatment-resistant OCD. Method: Eleven female outpatients, after full explanation of the procedure for them and obtaining assigned informed consent, entered the study. The mean +/SD age of the subjects was