Dr. Bob's Psychopharmacology Tips

Augmentation for OCD

Date: Mon, 15 Apr 1996 12:03:44 -0400 (EDT)
From: Nancy Breslin <breslin@gwis2.circ.gwu.edu>
Subject: Augmentation for OCD

Regarding possible augmentation of SSRIs for OCD, Jenike et al (Jenike MA, Baer L, Buttolph L. Buspirone augmentation of fluoxetine in patients with obsessive compulsive disorder. Journal of Clinical Psychiatry. 52 (1): 13-4, 1991 Jan.) did an open trial suggesting that buspirone can effectively augment fluoxetine. I have tried this in one patient and found a modest response. Jenike indicated a plan to do a controlled trial, but I haven't seen it.

There are also some reports of risperidone being helpful. Jacobson (Jacobsen FM. Risperidone in the treatment of affective illness and obsessive-compulsive disorder. Journal of Clinical Psychiatry. 56 (9): 423-9, 1995 Sep.) added it to sertraline and/or clomipramine in an open trial with 5 patients, and all were reported improved.

Date: Tue, 16 Apr 1996 10:43:27 -0600
From: dr-bob@uchicago.edu (Robert Hsiung)
Subject: Augmentation of SSRIs for OCD

Sometimes clomipramine and an SSRI are used together, with, of course, close monitoring, since the latter will inhibit the metabolism of the former.

From: MKomrad@aol.com
Date: Fri, 19 Apr 1996 23:02:37 -0400
Subject: Augmentation of clomipramine for OCD

There was an article in J Clin Psych about a year ago concerning bromocriptine augmentation of clomipramine for OCD. They used up to 30 mg/day. In one patient they had dramatic remission of OCD after "lifelong" sxs and multiple treatment trials.

From: MataKeata@aol.com (Matt Keats)
Date: Sat, 15 Jun 1996 12:53:06 -0400
Subject: Augmentation of SSRIs for OCD

Here's a new twist: a psychiatrist added fenfluramine/phentermine to an already established SSRI regimen for a patient with apparently treatment resisitant OCD. I seem to recall reading somewhere of using fenfluramine for OCD treatment augmentation and once heard Susan Swedo say that occasionally adding amphetamine to an SSRI might help.

Date: Sat, 15 Jun 1996 16:06:11 -0400
From: Ivan Goldberg <Psydoc@psycom.net>
Subject: Augmentation with fenfluramine for OCD

The use of fenfluramine to potentiate anti-obsessional agents is mentioned in the chapter on psychopharmacology of anxiety disorders in volume 2 of the 1995 Psychiatric Clinics of North America Annual of Drug Therapy.

From: snagymd@MEM.po.com (Stephen Nagy, M.D.)
Date: Mon, 17 Jun 1996 12:46:18 -0400
Subject: Augmentation with fenfluramine for OCD

See:

Hollander E, DeCaria CM, Schneier FR, Schneier HA, Liebowitz MR, Klein DF. Fenfluramine augmentation of serotonin reuptake blockade antiobsessional treatment. Journal of Clinical Psychiatry. 51 (3): 119-23, 1990 Mar.

Seven patients who met DSM-III criteria for OCD with a partial response to fluoxetine, fluvoxamine, or clomipramine took 20 to 60 mg per day of fenfluramine, with a further decrease in obsessions and compulsions in six of the patients.

Date: Sun, 21 Jul 1996 13:45:20 -0400
From: Ivan Goldberg <Psydoc@psycom.net>
Subject: Augmentation of SSRIs for OCD

At 11:29 AM 7/21/96 -0400, Richard David Brand, MD wrote:

Have an OCD pt with a partial response to fluvoxamine 200 mg who cannot tolerate more. Any thoughts about adjunctive clomipramine?

Date: Sun, 21 Jul 1996 16:28:34 -0700
From: Eduardo Dunayevich <dunayev@penn.com>
Subject: Augmentation of SSRIs for OCD

That is OK to do provided that you start with the lowest dose of clomipramine. Fluvoxamine blocks cyp1a2, which demethylates clomipramine into desmethylclomipramine (the noradrenergic metabolite). This may work to your advantage, as it will be fairly inexpensive to reach therapeutic levels of clomipramine, but you can run into side effects or toxicity fairly easy.

Date: Mon, 22 Jul 1996 23:05:34 -0500
From: gdavidson@sympatico.ca (George Davidson)
Subject: Augmentation of clomipramine for OCD

I have a patient whose OCD did not respond to any SSRIs, or venlafaxine, but had a nicely improved mood on fluvoxamine. Hearing that she had a cousin whose OCD responded to clomipramine, I started my patient on that, with good OCD results. Her mood was not great, so I added fluvoxamine, with better OCD results and good mood.

Date: Wed, 5 Feb 1997 17:59:35 +1300
From: david.menkes@stonebow.otago.ac.nz (David Menkes)
Subject: Augmentation of sertraline for OCD with depression

A few more bits of data, for what they're worth: I sent to the Br J Psychiatry a letter regarding good response to buspirone augmentation of sertraline in OCD with depression:

Menkes, DB. Buspirone augmentation of sertraline. British Journal of Psychiatry. 166 (6): 823-824, Jun 1995.

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