Ondansetron augmentation in patients with obsessive-compulsive disorder who are inadequate responders to serotonin reuptake inhibitors

Improvement with treatment and worsening following discontinuation

Stefano Pallanti, Silvia Bernardi, Sarah Antonini, Nikhilesh Singh, Eric Hollander

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Object: The aim of this study was to evaluate low-dose ondansetron as an augmentation strategy in patients with obsessive-compulsive disorder (OCD) who do not adequately respond to serotonin reuptake inhibits (SRIs). Methods: Twenty-one OCD patients who had not responded adequately to an SRI received 12 weeks of single-blind ondansetron augmentation initiated at 0.25. mg BID for 2 weeks, and titrated to 0.5. mg BID for an additional 10 weeks. Patients were rated every two weeks using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impressions Scale (CGI). Treatment response was defined as an additional 25% reduction in YBOCS score from the score at the initiation of ondansetron augmentation, an end of treatment YBOCS score of ≤24 and a CGI-Improvement (CGI-I) score of ≤2. Upon completion of treatment course patients were followed for 4 weeks. Results: At week 12, twelve of the 21 (57%) patients were responders. The average reduction in the YBOCS score for the overall group was 27.2%. Responders had an average 44% YBOCS score reduction and 76.9% CGI-I reduction. After discontinuation of ondansetron the YBOCS worsened an average of 15.5% in the entire sample and 38.3% in the responder subsample. No clinically meaningful side effects were reported. Conclusion: OCD patients who do not adequately respond to an SRI may benefit from augmentation with a low-dose of ondansetron. This may provide an alternative approach to augmentation with atypical antipsychotic agents, with a more favorable safety profile.

Original languageEnglish (US)
Pages (from-to)375-380
Number of pages6
JournalEuropean Neuropsychopharmacology
Volume24
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Ondansetron
Obsessive-Compulsive Disorder
Serotonin Uptake Inhibitors
Serotonin
Therapeutics
Antipsychotic Agents
Safety

Keywords

  • 5-HT3
  • Augmentation
  • Low-dose ondansetron
  • OCD

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Pharmacology (medical)
  • Biological Psychiatry
  • Neurology
  • Pharmacology
  • Medicine(all)

Cite this

Ondansetron augmentation in patients with obsessive-compulsive disorder who are inadequate responders to serotonin reuptake inhibitors : Improvement with treatment and worsening following discontinuation. / Pallanti, Stefano; Bernardi, Silvia; Antonini, Sarah; Singh, Nikhilesh; Hollander, Eric.

In: European Neuropsychopharmacology, Vol. 24, No. 3, 03.2014, p. 375-380.

Research output: Contribution to journalArticle

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title = "Ondansetron augmentation in patients with obsessive-compulsive disorder who are inadequate responders to serotonin reuptake inhibitors: Improvement with treatment and worsening following discontinuation",
abstract = "Object: The aim of this study was to evaluate low-dose ondansetron as an augmentation strategy in patients with obsessive-compulsive disorder (OCD) who do not adequately respond to serotonin reuptake inhibits (SRIs). Methods: Twenty-one OCD patients who had not responded adequately to an SRI received 12 weeks of single-blind ondansetron augmentation initiated at 0.25. mg BID for 2 weeks, and titrated to 0.5. mg BID for an additional 10 weeks. Patients were rated every two weeks using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impressions Scale (CGI). Treatment response was defined as an additional 25{\%} reduction in YBOCS score from the score at the initiation of ondansetron augmentation, an end of treatment YBOCS score of ≤24 and a CGI-Improvement (CGI-I) score of ≤2. Upon completion of treatment course patients were followed for 4 weeks. Results: At week 12, twelve of the 21 (57{\%}) patients were responders. The average reduction in the YBOCS score for the overall group was 27.2{\%}. Responders had an average 44{\%} YBOCS score reduction and 76.9{\%} CGI-I reduction. After discontinuation of ondansetron the YBOCS worsened an average of 15.5{\%} in the entire sample and 38.3{\%} in the responder subsample. No clinically meaningful side effects were reported. Conclusion: OCD patients who do not adequately respond to an SRI may benefit from augmentation with a low-dose of ondansetron. This may provide an alternative approach to augmentation with atypical antipsychotic agents, with a more favorable safety profile.",
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AB - Object: The aim of this study was to evaluate low-dose ondansetron as an augmentation strategy in patients with obsessive-compulsive disorder (OCD) who do not adequately respond to serotonin reuptake inhibits (SRIs). Methods: Twenty-one OCD patients who had not responded adequately to an SRI received 12 weeks of single-blind ondansetron augmentation initiated at 0.25. mg BID for 2 weeks, and titrated to 0.5. mg BID for an additional 10 weeks. Patients were rated every two weeks using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impressions Scale (CGI). Treatment response was defined as an additional 25% reduction in YBOCS score from the score at the initiation of ondansetron augmentation, an end of treatment YBOCS score of ≤24 and a CGI-Improvement (CGI-I) score of ≤2. Upon completion of treatment course patients were followed for 4 weeks. Results: At week 12, twelve of the 21 (57%) patients were responders. The average reduction in the YBOCS score for the overall group was 27.2%. Responders had an average 44% YBOCS score reduction and 76.9% CGI-I reduction. After discontinuation of ondansetron the YBOCS worsened an average of 15.5% in the entire sample and 38.3% in the responder subsample. No clinically meaningful side effects were reported. Conclusion: OCD patients who do not adequately respond to an SRI may benefit from augmentation with a low-dose of ondansetron. This may provide an alternative approach to augmentation with atypical antipsychotic agents, with a more favorable safety profile.

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