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Antipsychotic augmentation in SSRI treatment refractory OCD

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. Since then there as been much discussion and controversy around the effectiveness of anti-psychotics medications for the treatment of OCD, with one research project suggesting they were ineffective, faring little better than a placebo.

In a more recent research trial led by Dr David Veale, a research trial aimed to systematically review and conduct a meta-analysis on the clinical effectiveness of atypical anti-psychotics augmenting an SSRI. Two studies found aripiprazole and risperidone can for some be effective in the short-term for those who failed to respond to previous treatment with CBT and SSRI medications. The trial found that 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.

In summary Dr Veale told us that for some people low dosages of aripiprazole or risperidone might be helpful for some with OCD but if the augmentation is not working at 4 weeks then it's most likely not to be effective so should be discussed with your prescribing doctor and potentially could be discontinued.

Click below to read the full research paper.

Research Team: David Veale, Sarah Miles, Nicola Smallcombe, Haben Ghezai1, Ben Goldacre and John Hodsoll

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