Augmentation therapy is strategy that is being explored as a way to improve the odds of relieving OCD symptoms when treating OCD with medication. Augmentation therapy involves using combinations of drugs, rather than a single drug, for maximum effect. Augmentation strategies could be especially effective for people who do not respond to standard treatment.
Why Augmentation Therapy?
If you have OCD, you may know that a variety of treatments are available. However, you may also know that not all people respond to these treatments. Although the introduction of selective serotonin reuptake inhibitors (SSRIs) such as Luvox (Fluvoxamine), Prozac (Fluoxetine), Paxil (Paroxetine) and Zoloft (Sertraline), and tricyclic antidepressants such as Anafranil (Clompiramine) have been a huge step forward in the treatment of OCD, 40% to 60% of people will not respond adequately to these drugs. As in other areas of medicine, psychiatrists are now exploring whether treatment of OCD with a combination of medications, rather than a single medication, offers more relief, for more people.
Antipsychotic Medications are Used to Augment Current Treatments
Although antidepressants are the standard medical treatment for OCD, it has been suggested that adding antipsychotic drugs to a treatment plan could be helpful in improving OCD symptoms. Why is this?
First, antipsychotic medications such as Risperdal (Respiridone), Zyprexa (Olanzapine) or Seroquel (Quetiapine) affect levels of the neurotransmitter dopamine. Problems with the dopamine system have been implicated in OCD.
In addition, some people with OCD have difficulty believing that their obsessions and/or compulsions are illogical or unreasonable. A failure to recognize that obsessions and/or compulsions do not make sense has been shown to be a barrier to benefiting from standard treatments. It has been suggested that antipsychotic medications may be effective in helping change this pattern of thinking.
Does Augmentation Therapy Work?
In general, the available scientific evidence strongly supports the use of antipsychotic medications as useful augmentating drugs for adults whose OCD symptoms have not responded to standard treatments.
However, you must keep in mind that there are two categories of antipsychotic medications, each with their own potential side effects. The first generation or "typical" antipsychotics tend to have side effects related to abnormal movements such as tardive dyskinesia, which involves involuntary and uncontrollable movement of different parts of the body including the mouth and face. Tardive dyskinesia can sometimes be permanent if not addressed promptly.
The second generation or "atypical" antipsychotics usually have less risk of tardive dyskinesia, but can cause metabolic problems such as weight gain and elevated blood sugars and cholesterol.
Given this, the potential benefits of using an antipsychotic medication as an augmentation strategy for reducing OCD symptoms should outweigh the risks. In this respect, the relatively less severe side effects of the second generation or atypical antipsychotics often make them a first choice as augmentation agents.
As with any medical treatment, the decision to add an antipsychotic medication to your current treatment plan is a choice that should be made in strong collaboration with your family doctor or psychiatrist.
Sources:
Bloch, M.H., Landeros-Weisenberger, A., Kelmendi, B., Coric, V., Bracken, M.B., & Leckman, J.F. “A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder” Molecular Psychiatry 2006 11: 622-632.
Skapinakis, P., Papatheodorou T., & Mavreas, V. “Antipsychotic augmentation of serotonergic antidepressants in treatment-resistant obsessive-compulsive disorder: A meta-analysis of the randomized controlled trials” European Neuropsychopharmacology 2007 17: 79-93.
