OCD and Atypical Antipsychotics
While the frontline treatment for obsessive-compulsive disorder continues to be Exposure and Response Prevention (ERP) therapy, many who suffer from obsessive-compulsive disorder also appear to be helped by medication. Often the combination of ERP therapy and medication, typically high doses of selective serotonin reuptake inhibitors (SSRIs, also prescribed for depression) seems to be particularly helpful.
This was the route taken with my son Dan when his OCD was severe. He also was taking a benzodiazepine. He was making progress, slowly but surely, in his fight against OCD but was subsequently prescribed an atypical antipsychotic, also known as second generation antipsychotics. Some brand names of these drugs include Abilify and Risperdal. The explanation given to us was that this addition would “enhance” the effects of the SSRI Dan was currently taking.
In his case, this was a recipe for disaster. He became increasingly agitated and depressed, and developed some overall shakiness, including hand tremors. When my husband and I expressed our concerns to his doctor, we were told our son absolutely needed all his medications. As time went on, tachycardia (fast heart rate), sky-high triglycerides, and a weight gain of 35 pounds in several months were added to his list of side effects. And his OCD seemed worse. We finally had enough and insisted he be weaned off his medications. Not surprisingly, his side effects abated and his OCD also improved.
Recent studies have shown what had been obvious to my husband and me: Atypical antipsychotics can exacerbate the symptoms of obsessive-compulsive disorder and can even cause OCD to appear in those without the disorder. This fact does not seem to be widely known by the public, including many therapists.
In another study conducted by researchers at Columbia University and The University of Pennsylvania, participants already taking an SSRI to treat their OCD were separated into three groups. One group was given seventeen sessions of ERP therapy, one group was given Risperdal, and the final group was given a placebo. Those in the ERP group had, on average, a 52 percent reduction in their OCD severity scores. Those in the Risperdal group showed a 13 percent reduction and those in the placebo group had an 11 percent reduction.
Based on this study, it is clear that ERP therapy appears to be the most effective treatment for OCD. Risperdal did not provide any statistically significant benefit over that of a placebo. We all need to be very careful when pursuing treatment for obsessive-compulsive disorder and be sure to have a competent treatment provider whom we trust and who will listen to our concerns. Given the results of these recent studies, I would think long and hard before taking atypical antipsychotics for the treatment of OCD. I just hope doctors will think long and hard before prescribing them.