Augmentation strategies for treatment-resistant obsessive-compulsive disorder

This review discusses augmentation strategies for patients with obsessive-compulsive disorder who fail to respond to treatment. A patient's failure to respond to treatment may be due to any of a number of factors, such as noncompliance with a behavioral program, concurrent severe depression or personality disorder, certain ritualistic behaviors, inaccurate diagnosis, and inadequate treatment. It is particularly important that comorbid psychiatric disorders be diagnosed and treated. A review of the literature and my experience with the use of augmenting agents such as lithium, buspirone, clonidine, fenfluramine, antidepressants, anxiolytic agents, and neuroleptics in treatment-resistant obsessive-compulsive disorder are presented. Existing evidence suggests that some of these approaches are useful for some patients. However, many questions remain, and much research remains to be done on this topic.