Using Augmentation Therapy to Treat OCD

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Augmentation strategies involve using combinations of drugs, rather than a single OCD medication. Augmentation therapy involves using combinations of drug, rather than a single OCD medication, for maximum effect. Augmentation strategies could be especially effective for people who do not respond to standard OCD medication.

Why Augmentation Is Used

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 (clomipramine) have been a huge step forward in the treatment of OCD, 40 percent to 60 percent 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.

Using Antipsychotic Medications 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 (risperidone), Zyprexa (olanzapine) or Seroquel (quetiapine) affect levels of the neurotransmitter dopamine in addition to influencing serotonin. Problems with the dopamine system have also been implicated in OCD.

In addition, some people with OCD may 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 suggests the use of antipsychotic medications may be useful augmentation drugs for adults whose OCD symptoms have not responded to standard treatments, however further research is warranted.

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, referred to as extrapyramidal side effects such as rigidity, tremors, slowness, restlessness and tardive dyskinesia, which involves the involuntary and uncontrollable movement of different parts of the body including the mouth and face. Tardive dyskinesia can sometimes be permanent.

The second-generation or "atypical" antipsychotics usually have less risk of extrapyramidal side effects but are more likely to 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.

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.

OCD Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

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Be sure to communicate any changes you experience when trying a new medication or when switching medications, too. Keeping this open line of discussion between you and your doctor will ensure that he/she is keeping your individualized needs in mind when progressing in your treatment plan.

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  1. Bloch MH, Landeros-weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006;11(7):622-32. doi: 10.1038/sj.mp.4001823

  2. 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. Eur Neuropsychopharmacol. 2007;17(2):79-93. doi:10.1016/j.euroneuro.2006.07.002

  3. Obsessive-compulsive disorder. National Institute of Mental Health. Published online, updated October 2019.

Additional Reading
  • 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.