Treatment-resistant OCD: Pharmacotherapies in adults

Serotonin reuptake inhibitor (SRI) medications are well established as first-line pharmacotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). However, despite the excellent safety profile and demonstrated efficacy of these medications, a substantial proportion of individuals with OCD fail...

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Vydáno v:Comprehensive psychiatry Ročník 120; s. 152352
Hlavní autoři: van Roessel, Peter J., Grassi, Giacomo, Aboujaoude, Elias N., Menchón, José M., Van Ameringen, Michael, Rodríguez, Carolyn I.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.01.2023
Elsevier Limited
Elsevier
Témata:
Adults
Anti-Inflammatory Agents
Clinical trials
Comorbidity
Drug resistance
Drug therapy
FDA approval
Gender
Hoarding disorder
Humans
Metacognition
Neurosciences
Obsessive compulsive disorder
Obsessive-Compulsive Disorder - diagnosis
Obsessive-Compulsive Disorder - drug therapy
OCD
Patients
Pharmacotherapy
Psychotherapy
Serotonin
Treatment resistance
Treatment-resistant
Treatment-resistant
Pharmacotherapy
OCD
ISSN:0010-440X, 1532-8384, 1532-8384
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Shrnutí:Serotonin reuptake inhibitor (SRI) medications are well established as first-line pharmacotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). However, despite the excellent safety profile and demonstrated efficacy of these medications, a substantial proportion of individuals with OCD fail to attain sufficient benefit from SRIs. In this narrative review, we discuss clinical features of OCD that have been associated with poorer response to SRIs, and we present pharmacotherapeutic interventions that have been explored as augmenting or alternative treatments for treatment-resistant OCD. We additionally highlight non-SRI interventions for OCD that are currently under investigation. Pharmacotherapeutic interventions were identified via expert consensus. To assess the evidence base for individual pharmacotherapies, targeted searches for relevant English-language publications were performed on standard biomedical research databases, including MEDLINE. Information relevant to ongoing registered clinical trials in OCD was obtained by search of ClinicalTrials.gov. Pharmacotherapies are grouped for review in accordance with the general principles of Neuroscience-based Nomenclature (NbN). Clinical features of OCD that may suggest poorer response to SRI treatment include early age of onset, severity of illness, duration of untreated illness, and the presence of symmetry/ordering or hoarding-related symptoms. Based on evolving pathophysiologic models of OCD, diverse agents engaging serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Medications with dopamine antagonist activity remain the most robustly evidence-based of augmenting interventions, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Interventions targeting glutamatergic and anti-inflammatory pathways are less well evidenced, but may offer more favorable benefit to risk profiles. Ongoing research should explore whether specific interventions may benefit individuals with particular features of treatment-resistant OCD. •Many individuals with OCD do not sufficiently benefit from first-line treatment with serotonin reuptake inhibitors.•A broad range of pharmacotherapies have been explored as adjunctive or alternative interventions for treatment-resistant OCD.•Glutamatergic and anti-inflammatory interventions, among others, may offer favorable benefit to risk profiles.•Dopamine antagonist treatments remain the best evidenced augmentation strategy for treatment-resistant OCD.
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ISSN:0010-440X
1532-8384
1532-8384
DOI:10.1016/j.comppsych.2022.152352