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Risperidone addition in fluvoxamine-refractory obsessive-compulsive disorder: three cases

C J McDougle¹, R L Fleischmann, C N Epperson

¹Department of Psychiatry, Yale University, New Haven, CT 06519, USA.

The Journal of Clinical Psychiatry

|November 1, 1995

Summary

Adding risperidone to serotonin uptake inhibitors (SUIs) significantly improved obsessive-compulsive disorder (OCD) symptoms in three patients. This combination therapy offers a potential new treatment for refractory OCD cases.

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Area of Science:

Psychiatry
Pharmacology

Background:

Many patients with obsessive-compulsive disorder (OCD) do not respond adequately to serotonin uptake inhibitors (SUIs).
Alternative treatments for SUI-refractory OCD are needed, considering the risk of tardive dyskinesia with typical neuroleptics.

Observation:

This study reports on three OCD patients treated with fluvoxamine (an SUI) who showed no improvement.
Risperidone was added to their ongoing fluvoxamine treatment in an open-label manner.

Findings:

All three patients experienced significant reductions in OCD symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
Within four weeks, Y-BOCS scores decreased by 65%, 56%, and 43% after adding low-dose risperidone (1 mg/day) to fluvoxamine (250-300 mg/day).
The primary side effect noted was mild to moderate sedation.

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Implications:

Adding risperidone to SUIs may be an effective strategy for treating SUI-refractory OCD.
Risperidone, a selective serotonin2 and dopamine2 antagonist, presents a potentially safer alternative to typical neuroleptics for long-term OCD pharmacotherapy.