Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders

Background: While serotonin is the neurotransmitter most commonly implicated in obsessive-compulsive and related disorders, there is also evidence for dopaminergic mediation of these conditions. Indeed, augmentation of serotonin reuptake inhibitors with the atypical neuroleptic risperidone has been suggested to be useful in obsessive-compulsive disorder (OCD). Method: Charts of all patients treated in our OCD clinic with the combination of a serotonin reuptake inhibitor and risperidone were reviewed. Demographic details of patients and clinical response to this pharmacotherapeutic strategy were tabulated. Results: A series of patients with OCD (N = 8), trichotillomania (N = 5), and Tourette's syndrome (N = 3) who were refractory to treatment with serotonin reuptake inhibitors had received risperidone augmentation. In a number of cases, this strategy proved clinically effective. However, a minority of patients experienced significant adverse effects. Conclusion: Patients with OCD and related disorders are not infrequently refractory to treatment with serotonin reuptake inhibitors. Controlled trials of risperidone augmentation in such patients seem warranted. In particular, it is necessary to determine an appropriate dose range to minimize adverse effects.