DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20193196

Randomized, single blinded comparative study of selective serotonin reuptake inhibitor augmentation with olanzapine v/s amisulpride for obsessive compulsive disorder

O. P. Raichandani, J. N. Chaturvedi

Abstract


Background: Obsessive-Compulsive Disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) as an anxiety disorder. Serotonin reuptake inhibitors are considered to be most effective and are the first line pharmacotherapy for the treatment of OCD. However, about 40-60% of OCD patients fail to respond to SSRI mono-therapy. Further, as many as 25% of patients fails to experience any improvement from initial SSRIs mono-therapy. For non-responder’s low dose augmentation with antipsychotics (risperidone, quetiapine, olanzapine, aripirazole, amisuplride etc.) has shown promising response, as compared to serotonin enhancers. The present study is designed to evaluate and compare the efficacy and adverse drug reactions of these two antipsychotics viz. Olanzapine and amisulpride as augmentation strategy in OCD patients. Objective of present study was to compare the efficacy of olanzapine and amisulpride as add on therapy for inadequately controlled obsessive-compulsive disorder patients on selective-serotonin reuptake inhibitor.

Methods: the present study was done at Medical College Jabalpur (M.P.) in the department of Psychiatry & Pharmacology. It was randomized, patient blinded study. 47 patients were screened for the study out of which 36 were enrolled and randomized into either SSRI+Olanzapine or SSRI+Amisulpride group. The patients were evaluated at baseline and then biweekly for 12 weeks to assess the efficacy of these drugs as augmentation strategy using Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

Results: There was a significant improvement in Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression-Severity (CGI-S) score and Clinical Global impression-Improvement (CGI-I) score in both the groups but there was no significant difference (P>0.05) in either of these groups on these three scale. No serious adverse drug reaction was reported in either of these groups.

Conclusions: Both olanzapine and amisulpride are efficacious and well tolerated for augmentation of SSRI with no significant difference in their efficacy.


Keywords


Amisulpride, Augmentation, Obsessive Compulsive Disorder, Olanzapine, Selective Serotonin Reuptake Inhibitors

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References


American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, Text Revision (DSM-IV-TR). Washington, DC; 2000.

Murray CJL, Lopez AD, eds. Global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Vol 1. Boston: Harvard Press; 1996.

Khanna S, Gururaj G, Sriram TG. Epidemiology of obsessive-compulsive disorder in India. Presented at: The first International Obsessive-Compulsive Disorder Congress; 1993 March;9-12; Capri.

Hollander E, Greenwald S, Neville D, Johnson J, Hornig CD, Weissman MM. Uncomplicated and comorbid obsessive-compulsive disorder in an epidemiologic sample. CNS Spectrums. 1998 May;3(S1):10-8.

NIMH Anxiety Disorder Publication [Internet]. Updated April 2008. Available at: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder ocd/index.shtml. Accessed 24 September 2011.

Clomipramine Collaborative Study Group. Clomipramine in the treatment of patients with obsessive-compulsive disorder. Arch Gen Psychiatry. 1991;48:730-8.

Skoog G, Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry. 1999 Feb 1;56(2):121-7.

Berrios GE, Chiu H. Obsessive-compulsive disorders in Cambridgeshire: a follow-up study of up to 20 years. Brit J Psychiatry. 1989 May;154(S4):17-20.

Expert Consensus Panel for Obsessive-Compulsive Disorder. Treatment of obsessive-compulsive disorder. J Clin Psychiatry. 1997;58(suppl 4): 2-72.

Erzegovesi S, Cavallini MC, Cavedini P, Diaferia G, Locatelli M, Bellodi L. Clinical predictors of drug response in obsessive-compulsive disorder. J Clin Psychopharmacol. 2001 Oct 1;21(5):488-92.

Ravizza L, Barzega G, Bellino S, Bogetto F, Maina G. Predictors of drug treatment response in obsessive-compulsive disorder. J Clin Psychiatry. 1995;56(8):368-73.

Wheadon DE, Bushnell WD, Steiner M. A fixed-dose comparison of 20, 40 or 60 mg paroxetine or placebo in the treatment of obsessive-compulsive disorder. Presented at the 32nd Annu Meeting Am Col Neuropsychopharmacol. 1993 Dec;13-17.

Mcdougle CJ, Price LH, Goodman WK, Charney DS, Heninger GR. A controlled trial of lithium augmentation in fluvoxamine-refractory obsessive-compulsive disorder: lack of efficacy. J Clin Psychopharmacol. 1991 Jun;11(3):175-84.

Pigott TA, L'Heureux F, Hill JL, Bihari K, Bernstein SE, Murphy DL. A double-blind study of adjuvant buspirone hydrochloride in clomipramine-treated patients with obsessive-compulsive disorder. Journal of clinical psychopharmacology. J Clin Psychopharmacol. 1992 Feb;12(1): 11-18.

McDougle CJ, Goodman WK, Price LH, Delgado PL, Krystal JH, Charney DS et al. Neuroleptic addition in fluvoxamine-refractory obsessive compulsive disorder. Am J Psychiatry 1990;147(5):652-654.

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.

Insel TR. Toward a neuroanatomy of obsessive-compulsive disorder. Arch Gen Psychiatry. 1992 Sep 1;49(9):739-44.

Goodman WK, McDougle CJ, Price LH, et al. Beyond the serotonin hypothesis: a role for dopamine in some forms of obsessive compulsive disorder? J Clin Psychiatry. 1990;51(Suppl):36-43.

Olanzapine Prescribing Information. [Internet]. 1997 [Updated 2009 March 19; cited 2011 Sep. 15]. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020592s051,021086s030,021253s036lbl.pdf.

Bymaster FP, Calligaro DO, Falcone JF, Marsh RD, Moore NA, Tye NC, Seeman P, Wong DT. Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology. 1996 Feb;14(2):87-96.

Rosenzweig P, Canal M, Patat A, Bergougnan L, Zieleniuk I, Bianchetti G. A review of the pharmacokinetics, tolerability and pharmacodynamics of amisulpride in healthy volunteers. Human Psychopharmacology: Clinical and Experimental. 2002 Jan;17(1):1-3.

Metin Ö, Yazici K, Tot S, Yazici AE. Amisulpiride augmentation in treatment resistant obsessive–compulsive disorder: an open trial. Human Psychopharmacology: Clinical and Experimental. 2003 Aug;18(6):463-7.

Shapira NA, Ward HE, Mandoki M, Murphy TK, Yang MC, Blier P, Goodman WK. A double-blind, placebo-controlled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder. Biol Psychiatry. 2004 Mar 1;55(5):553-5.

Bystritsky A, Ackerman DL, Rosen RM, Vapnik T, Gorbis E, Maidment KM, et al. Augmentation of serotonin reuptake inhibitors in refractory obsessive-compulsive disorder using adjunctive olanzapine: a placebo-controlled trial. J Clin Psychiatry. 2004 Apr;65:565-8.

Weiss EL, Potenza MN, McDougle CJ, Epperson CN. Olanzapine addition in obsessive-compulsive disorder refractory to selective serotonin reuptake inhibitors: an open-label case series. J Clin Psychiatry. 1999 Aug;60(8):524-7.

Francobandiera G. Olanzapine augmentation of serotonin uptake inhibitors in obsessive-compulsive disorder: an open study. Can J Psychiatry. 2001 May;46(4):356-8.

Maina G, Pessina E, Albert U, Bogetto F. 8-week, single-blind, randomized trial comparing risperidone versus olanzapine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder. Eur Neuropsychopharmacol. 2008 May;18(5):364-72.

D'Amico G, Cedro C, Muscatello MR, Pandolfo G, Di Rosa AE, Zoccali R, et al. Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2003 Jun;27(4):619-23.