Aripiprazole augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a 12-week open-label preliminary study

One of the most studied and well-documented strategies for treatment-resistant obsessive-compulsive disorder (OCD) is the addition of antipsychotic drugs to the ongoing serotonin reuptake inhibitor (SRI) treatment. To date, there has been a paucity of data regarding the use of aripiprazole in OCD patients who failed to respond to SRIs. The aim of the present pilot study was to investigate the efficacy of flexible doses of aripiprazole as augmenting agent in the treatment of resistant OCD patients. Patients meeting the inclusion criteria of treatment-resistant OCD entered a 12-week, open-label, flexible-dose trial of aripiprazole addition to SRIs. Aripiprazole was started at 5 mg/day and increased up to a maximum of 20 mg/day. Twelve patients fulfilled entry criteria; nine patients took at least one dose of study medication and eight of them completed the study. The mean daily dosage of aripiprazole in completers was 11.2+/-5.2 mg/day. Patients showed a significant improvement over the 12-week study period (paired t-test for mean Yale-Brown Obsessive Compulsive Scale total score at week 12 as compared with baseline - all patients: t = 4.860, d.f. = 8, P = 0.001). The most common adverse event reported was inner unrest reported by four (44.4%) patients. Our study supports the notion that adding aripiprazole to SRIs could be a valid strategy for treatment-resistant OCD patients, and points towards the need of randomized, double-blind studies.