Abstract
BackgroundIn 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. The article aims to systematically review and conduct a meta-analysis on the clinical effectiveness of atypical anti-psychotics augmenting an SSRI.MethodsStudies that were double-blind randomized controlled trials of an atypical antipsychotic against a placebo, for a minimum of 4 weeks, in adults with OCD, were included. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. Inclusion criteria included Y-BOCS score of 16 or more and at least one adequate trial of a SSRI or clomipramine for at least 8 weeks prior to randomization. Data sources included Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews (CDSR), trial registries and pharmaceutical databases and manufacturers up to September 2013. Forest-plots were drawn to display differences between drug and placebo on the Y-BOCS.ResultsTwo studies found aripiprazole to be effective in the short-term. There was a small effect-size for risperidone or anti-psychotics in general in the short-term. We found no evidence for the effectiveness of quetiapine or olanzapine in comparison to placebo.ConclusionsRisperidone 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.
Highlights
In 2006, the National Institute of Clinical and Health Excellence (NICE) guidelines for Obsessive Compulsive Disorder (OCD) recommended anti-psychotics as a class for Selective Serotonin Reuptake Inhibitor (SSRI) treatment resistant OCD
Our question for the systematic review was: “For adults who have OCD which has failed to respond to at least one trial of a serotonergic reuptake inhibitor, will an antipsychotic drug be more effective than a placebo, in reducing obsessive-compulsive symptoms?” Our secondary aim was to determine if guidance could be provided for the order of stepped care, and for the dose and duration for a trial of an anti-psychotic
We focused on the potential benefits of atypical antipsychotics as potential harms in the long-term are well documented in other populations [10] and no long term studies have been conducted in OCD [4]
Summary
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. Our question for the systematic review was: “For adults who have OCD which has failed to respond to at least one trial of a serotonergic reuptake inhibitor, will an antipsychotic drug be more effective than a placebo, in reducing obsessive-compulsive symptoms?” Our secondary aim was to determine if guidance could be provided for the order of stepped care, and for the dose and duration for a trial of an anti-psychotic
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