Quetiapine in obsessive-compulsive disorder
Similarly in the subgroup with co-morbid tics, no preferential benefit was noted for quetiapine. Interestingly, the high placebo response was similar to that seen in a recent failed controlled trial of olanzapine [ 25 ], but stands in contrast to the positive studies in this area in which low placebo response rates were seen when demonstrating efficacy of quetiapine [ 23 ], risperidone [ 21 ], and olanzapine [ 24 ].
It is likely that features of study design or specific study population characteristics may have contributed to this finding and these are discussed below, quetiapine in obsessive-compulsive disorder. First, the duration of a therapeutic trial of an SRI prior to augmentation with an antipsychotic should be of adequate dose and duration.
In our study the majority of participants had failed only the single trial of an SRI on which they continued during the study Notably only six weeks of this treatment was required at the maximum tolerated dose. Despite the notion that an optimum trial of pharmacotherapy in OCD is 12 weeks, it may be argued that higher and ultimately effective doses of an SRI had not been maintained for an optimum duration obsessive-compulsive to randomization.
It seems possible that the recent study by Shapira et al [ 25 ] may have been impacted by similar factors. In a second and related point; the number of previous SRI trials in the subgroup receiving quetiapine did not predict a poorer response to treatment. This effect is probably related to quetiapine lack of statistical power to detect these disorders in a disorder in which the low number of previous SRI trials was a distinguishing characteristic, quetiapine in obsessive-compulsive disorder.
Certainly, previous positive studies in this area have used relatively more refractory groups based on the number of obsessive-compulsive failed SRI trials. Third, the use of a slow up-titration resulted in a relatively low mean daily dose being administered for the majority of the study.
These doses are comparably low to those used in the negative single-blind study using low dose quetiapine by Sevincok et al [ 19 ]. In contrast the positive study using quetiapine by Denys et al [ 23 ] quetiapine a more rapid up-titration and a fixed-dose design. This meant that subjects were exposed to mg daily doses that were generally well tolerated, from the start of week 3. The authors of this study were able to show significant YBOCS differences between groups from the end of week 4.
Similarly Mc Dougle et al [ 21 ], quetiapine in obsessive-compulsive disorder, using risperidone, began treatment on 1 mg per day for one week and permitted weekly 1 mg incremental increases for order tizanidine online weeks.
They found that by the beginning of week 2, disorder subjects were on or around the mean daily dose for treatment responders 2. Despite the significant improvement in the quetiapine group quetiapine in our study, the apparent lack of benefit of doses higher than mg per day may seem surprising, however, we cannot rule out the possibility that administering these higher doses for an adequate duration obsessive-compulsive have changed the outcome.
Quetiapine augmentation in obsessive-compulsive disorder resistant to serotonin reuptake inhibitors: an open-label study.
As such it seems likely that a more aggressive up-titration schedule might have resulted in even higher obsessive-compulsive of withdrawal.
By comparison, rates of tramadol hydrochloride extended-release tablets 100mg were obsessive-compulsive high, quetiapine in obsessive-compulsive disorder, but did not appear to restrict use of the more rapid up-titration in the study by Denys et al [ 23 ].
Certainly evidence of efficacy using lower doses has been demonstrated in studies of 6 and 8 weeks duration [ 212324 ], and it seems that therapeutically adequate doses should probably be reached earlier than week 4 in a 6 week study.
Fourth, the impact of repeated clinical assessments and rating of relatively small changes in clinical severity combined with regular dose increases, may conceivably have increased the disorder response rates resulting from increased optimism, quetiapine in obsessive-compulsive disorder, a tendency to over-report disorders and belief that higher doses are more likely to be more effective than lower doses.
This may be particularly true for the placebo-treated group that were considerably less likely to report sedation as an adverse disorder and as such were more likely to prednisolone nycomed 5mg their treatment dose increased at each visit. Our results differ, with respect to placebo response, from a considerable literature that suggests a consistently lower placebo response rate in treatment trials in OCD than in other mood and anxiety disorders.
While we believe that the reasons 1—3 discussed above quetiapine provide the main reasons for our finding, the impact of repeated assessments and the potential effect thereof cannot be entirely discounted. Conclusions Despite significant improvement in each of the study groups, response to quetiapine augmentation in SRI non-responders, failed to separate from placebo treated subjects at the end of the six week treatment phase.
A number of limitations in study design make comparisons with previous studies in this area difficult and probably contributed to our negative findings. Future work in this important clinical area should address these limitations. Declarations Acknowledgements This study was funded by Astra Zeneca The authors wish to acknowledge the contribution of the participating investigators: Global burden of disease: WCA recommendations for the long-term treatment of obsessive-compulsive disorder in adults.
Pharmacotherapy for obsessive-compulsive disorder. Br J Psychiatry Suppl. A review of the efficacy of selective serotonin reuptake inhibitors in quetiapine disorder. Risperidone augmentation quetiapine SRI treatment for refractory obsessive-compulsive disorder.
Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and obsessive-compulsive disorders.
Risperidone augmentation in refractory obsessive-compulsive disorder: Olanzapine addition in obsessive-compulsive disorder refractory to selective serotonin reuptake inhibitors: Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder. Olanzapine augmentation of serotonin uptake inhibitors in obsessive-compulsive disorder: Open-label olanzapine in obsessive-compulsive disorder refractory to antidepressant treatment.
Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder Quetiapine Amisulpride augmentation in treatment-resistant obsessive-compulsive disorder. Quetiapine augmentation in patients with treatment obsessive-compulsive obsessive-compulsive disorder: Quetiapine addition to serotonin reputake inhibitor treatment in patients with treatment-refractory obsessive-compulsive disorder: Quetiapine augmentation of sertraline in obsessive-compulsive disorder.
Quetiapine augmentation of serotonin reuptake inhibitors in obsessive-compulsive disorder. Lack of efficacy of low doses of quetiapine addition in refractory obsessive-compulsive disorder.
Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, quetiapine in obsessive-compulsive disorder, placebo-controlled study in patients with quetiapine disorder tics, quetiapine in obsessive-compulsive disorder.
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A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder.
Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: A double-blind, quetiapine in obsessive-compulsive disorder, randomized, placebo-controlled trial of quetiapine addition in patients with disorder disorder quetiapine to serotonin reuptake inhibitors.
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Journal of Clinical Psychiatry. Augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder using adjunctive olanzapine: A double-blind, placebo-controlled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder.
Addition of Quetiapine in Obsessive Compulsive Disorder - Westenberg Study
Is the 5-HT 1Dbeta receptor gene implicated in the pathogenesis of obsessive-compulsive disorder?. Development, use, and reliability. A new depression scale designed to be sensitive to change.
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