A systematic review of the use of risperidone, paliperidone and aripiprazole as augmenting agents for obsessive-compulsive disorder

ABSTRACT

Introduction: Obsessive-compulsive disorder (OCD) is often viewed as a difficult to treat disorder. In some patients, antipsychotics are used to augment the action of serotonin reuptake inhibitors (SRIs), particularly when there is only a partial response to treatment.

Areas covered: This comprehensive literature review aims to assess the effectiveness and tolerability of three commonly used atypical antipsychotic agents: risperidone, paliperidone and aripiprazole, as augmentation agents in the treatment of OCD.

Expert opinion: Antipsychotic augmentation should only be trialed once treatment with selective SRIs at high dose and exposure and response prevention therapy have failed. Currently, there is evidence to support the use of risperidone, paliperidone and aripiprazole as augmentation agents for OCD in adult samples but more studies with larger samples are needed to assess predictors of response to antipsychotic augmentation and to detect any differential effects between the three agents. At this point in time, the choice of antipsychotic is best determined by the side effect profile of the drug and a patient’s medication history.

KEYWORDS:

• Obsessive-compulsive disorder
• antipsychotics
• pharmacotherapy
• treatment resistance

Article Highlights

• If SSRIs have failed or are only partially effective, first try exposure and response prevention (ERP).

• Antipsychotic augmentation has a role when SSRIs and ERP have proven ineffective.

• Paliperidone and aripiprazole have better adverse effect profiles than risperidone.

• There is more evidence to support the use of risperidone than paliperidone and aripiprazole

• There are no current predictors of response to antipsychotic augmentation using these three agents.

• There is no evidence to support the preferential use of one antipsychotic agent over another at this point in time.

This box summarizes key points contained in the article.

Declaration of interest

V Brakoulias declares receiving a Nepean Medical Research Foundation grant. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

E Stockings is supported by an Australian National Health and Medical Research Council Early Career Fellowship [APP1104600].