Olanzapine Augmentation for Treatment-Resistant Obsessive-Compulsive Disorder
J Clin Psychiatry 2000;61(7):514-517
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: Adding the atypical neuroleptic
risperidone to a serotonin reuptake inhibitor (SRI) has benefited
patients with treatment-refractory obsessive-compulsive disorder
(OCD). Since olanzapine and risperidone have similar serotonergic
and dopaminergic receptor binding profiles, we tested the
hypothesis that olanzapine augmentation would be beneficial in
Method: For this 8-week trial, we recruited 10
adult OCD patients (DSM-IV criteria) unresponsive to fluoxetine
(>= 60 mg/day) for >= 10 weeks, which was continued
throughout the trial. Other psychotropic medications were
discontinued. Subjects had OCD for >= 1 year, a Yale-Brown
Obsessive Compulsive Scale (Y-BOCS) score of >= 18, and no
organic, psychotic, or other primary Axis I disorder. Two weeks
after olanzapine, 2.5 mg/day, was added, and in the absence of
responder status (Y-BOCS score decrease >= 25%) and limiting
side effects, we increased the dose to 5 mg/day, and after 2 more
weeks, to 10 mg/day for 4 weeks.
Results: The subjects had failed a mean of 3.3
SRI trials (range, 1-5) and had a mean ± SD baseline Y-BOCS
score of 29.0 ± 4.9. Nine patients completed the trial. The
subjects' mean ± SD endpoint Y-BOCS score was 24.4 ± 8.0 (a 16%
decrease). The 3 responders' Y-BOCS scores dropped 68%, 30%, and
29%, but only 1 patient was rated "much improved." He
maintained this improvement during a 6-month follow-up period
taking olanzapine, 5 mg/day. Improvement in OCD was independent
of improvement in mood symptoms. Six patients (60%) experienced
significant weight gain.
Conclusion: Olanzapine augmentation may benefit
treatment-unresponsive OCD. Double-blind, placebo-controlled
trials are warranted along with trials comparing risperidone and