Ondansetron augmentation in treatment-resistant obsessive-compulsive disorder: A preliminary, single-blind, prospective study

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

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Background: Serotonin and dopamine neuronal systems have been implicated in the modulation of obsessive-compulsive disorder (OCD) symptoms. About 40% of OCD patients do not respond to first-line selective serotonin reuptake inhibitor (SSRI) treatment; among those, dopamine blocker augmentation has been reported to improve the rate of response by an additional one-third.Given that serotonin 5-HT3 receptors are indirect inhibitors of corticomesolimbic dopamine release, augmentation with the 5-HT3 receptor antagonist ondansetron in combination with SSRIs and antipsychotics has potential efficacy in treatment-resistant OCD patients. Objective: To assess the efficacy and tolerability of ondansetron in combination with SSRIs and antipsychotics in patients with treatment-resistant OCD. Method: In total, 14 patients with a DSM-IV diagnosis of OCD, who were treatment resistant and receiving stable treatment with SSRIs and antipsychotic augmentation, entered a 12-week, single-blind trial of ondansetron. The drug was initiated at a dosage of 0.25mg twice daily for 6 weeks and was then titrated to 0.5mg twice daily for 6 weeks. Results: Of the 14 patients, nine (64.3%) experienced a treatment response (25% reduction in the Yale-Brown Obsessive Compulsive Scale [YBOCS] score and a Clinical Global Impressions-Improvement [CGI-I] score of 1 or 2) at 12 weeks. The average reduction in YBOCS-rated symptoms for the whole group was 23.2%. None of the treated paients experienced symptom exacerbation or significant adverse effects. Conclusion: These results suggest that low-dose ondansetron may have promise as an augmentation strategy for some patients with OCD resistant to SSRIs and antipsychotic augmentation, but further controlled trials are required.

Original languageEnglish (US)
Pages (from-to)1047-1055
Number of pages9
JournalCNS Drugs
Volume23
Issue number12
DOIs
StatePublished - Dec 11 2009
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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