Adjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive???compulsive disorder: a meta-analysis of randomized controlled treatment trials
Abstract
Small studies have shown positive effects from adding a variety of antipsychotic agents in patients with obsessive-compulsive disorder who are unresponsive to treatment with serotonin reuptake inhibitors. The evidence, however, is contradictory. This paper reports a meta-analysis of existing double-blind randomized placebo-controlled studies looking at the addition of the second-generation antipsychotic quetiapine in such cases. Three studies fulfilled the inclusion criteria. Altogether 102 individuals were subjected to analysis using Review Manager (4.2.7). The results showed evidence of efficacy for adjunctive quetiapine (<400 mg/day) on the primary efficacy criterion, measured as changes from baseline in total Yale-Brown Obsessive Compulsive Scale scores (P=0.008), the clinical significance of which was limited by between-study heterogeneity. The mechanism underlying the effect may involve serotonin and/or dopamine neurotransmission.
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In OCD patients unresponsive to adequate SRI treatment, low-dose antipsychotic agents are sometimes added as an adjunct to SRIs.
“In cases where OCD patients are unresponsive to such treatment, given for an adequate duration and at an adequate dose, low‐dose antipsychotic agents are sometimes added as an adjunct to SRIs”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Fineberg et al., 2006
The Introduction (p. 1) describes adding antipsychotics to SRIs in treatment-resistant OCD, and the paper examines adjunctive quetiapine at under 400 mg/day. The Results (p. 2) describe patients who had not responded after weeks or months of SRI treatment, but the cited passages do not establish that their SRI doses were adequate; the Discussion (p. 5) also questions whether one study included truly resistant cases. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAntipsychotic drugs are usually potent serotonin 2a receptor (5-HT2AR) antagonists.
“Antipsychotic drugs are usually potent serotonin 2a receptor (5‐HT2AR) antagonists”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Fineberg et al., 2006
The Discussion (p. 6) describes 5-HT2A blockade as a proposed mechanism for several atypical antipsychotics. It does not establish that antipsychotic drugs are usually potent 5-HT2A antagonists; it also notes that haloperidol is much more potent at D2 than at 5-HT2A receptors. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe synergistic 5-HT2A antagonism explanation accounts for beneficial effects of strong 5-HT2A antagonists (quetiapine, risperidone) but not antipsychotics with higher D2 affinity (haloperidol).
“This seems to explain the reported beneficial effects of antipsychotics that are strong 5‐HT2A receptor antagonists (e.g., quetiapine and risperidone) but not antipsychotics with higher affinity instead for D2 receptors relative to 5‐HT2A (e.g., haloperidol)”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Fineberg et al., 2006
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Eddy, K. T., Dutra, L., Bradley, R., & Westen, D. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.08.004 · Cited by 475 · see citing works
Carey, P. D., Vythilingum, B., Seedat, S., Muller, J. E., van Ameringen, M., & Stein, D. J. (2005) · BMC Psychiatry · doi:10.1186/1471-244x-5-5 · Cited by 133 · see citing works
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Research works printed but not linked: 2
- Cochrane Collaboration (2004). Review Manager 4.2.7. Available at: http:// www.cc-ims.net/RevMan.
- Fineberg NA, Gale T, Sivakumaran T (2006). A review of antipsychotics in treatment resistant obsessive compulsive disorder (OCD). J Psychopharmacol 20 :97-103.
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Pharmacotherapy of obsessive–compulsive disorder: evidence-based treatment and beyond
Fineberg, N. A., Reghunandanan, S., Brown, A., & Pampaloni, I. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412461958 · Cited by 122 · see citing works
Self-citationObsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction
Jalal, B., Chamberlain, S. R., & Sahakian, B. J. (2023) · Brain and Behavior · doi:10.1002/brb3.3000 · Cited by 111 · see citing works
“Antipsychotic drugs are usually potent serotonin 2a receptor (5-HT2AR) antagonists (Fineberg et al., 2006; Marek et al., 2003).”
BackgroundBarton, S., Karner, C., Salih, F., Baldwin, D. S., & Edwards, S. J. (2014) · Health Technology Assessment · doi:10.3310/hta18500 · Cited by 36 · see citing works
- Authors
- Fineberg, N. A., Stein, D. J., Premkumar, P., Carey, P., Sivakumaran, T., Vythilingum, B., Seedat, S., Westenberg, H., & Denys, D.
- Affiliations
- Queen Elizabeth II Hospital (GB)
- Stellenbosch University (ZA)
- Hertfordshire Partnership University NHS Foundation Trust (GB)
- University Medical Center Utrecht (NL)
- Corresponding author
- Fineberg, Naomi A.
- Venue
- International Clinical Psychopharmacology
- Published
- 2006-11
- Volume
- 21
- Issue
- 6
- Pages
- 337-343
- ISSN
- 0268-1315 (ISSN-L)
- OpenAlex
- W2073515770
- Cited by
- 103
- References
- 2
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 3 · 2020: 44 · 2019: 7 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 6 · 2014: 4 · 2013: 1 · 2012: 6
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Clinical Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Nottingham Trent University's Institutional Repository (Nottingham Trent Repository) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- SUNScholar (Stellenbosch University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- quetiapine, obsessive-compulsive disorder, serotonin reuptake inhibitors, treatment-resistant OCD, atypical antipsychotics, Yale-Brown Obsessive Compulsive Scale
- MeSH terms
- Quetiapine Fumarate, Adult, Dibenzothiazepines, Drug Therapy, Combination, Female, Humans, Male, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Antipsychotic Agents, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors
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