Organized Chaos - Volume 5
Atypical Antipsychotics And Obsessive-Compulsive Disorder
by S.E. Stewart, M.D. & D.A. Geller, M.D.
In addition to SSRI's, Clomipramine and Benzodiazepines that have been already discussed in this series, "atypical" or "new generation" antipsychotics there is another group of medications used to treat Obsessive-Compulsive Disorder. The name "antipsychotic" used to describe these medications is derived from the FDA approved indications for their use. They are used to treat a number of other disorders. For example, these medications are often used as an additional or "adjunctive" medication to treat Obsessive-Compulsive Disorder, bipolar disorder, severe depression, Tourette's Syndrome, stuttering, anger outbursts, delirium and pervasive developmental (autistic spectrum) disorders.
Currently, the six atypical antipsychotics include Clozapine (Clozaril), Olanzapine (Zyprexa), Quetiapine (Seroquel), risperidone (Risperdal), Ziprasidone (Geodon) and Aripiprazole (Abilify). These are called "atypical" because they do not share all of the features of traditional antipsychotics. They have a wider spectrum of chemical actions and are less likely to cause movement side effects, such as muscle spasm (acute Dystonia), restlessness (Akithisia), and more serious long-term abnormal facial and body movements (Tardive Dyskinesia). Side effects that may occur with atypicals include fatigue (sedation), sleeplessness (insomnia), weight gain, stomach upset, dry mouth and eyes, constipation, and dizziness on standing (Orthostatic Hypotension). Rarely, sexual side effects may occur.
For a more complete list of side effects, speak with your doctor because other less common yet unwanted effects may occur.
These medications work by blocking receptors for chemicals in the brain including dopamine, serotonin, histamine and norepinephrine. Similar to many medications, it is not fully understood how "atypicals" improve symptoms of Obsessive-Compulsive Disorder. There have been some reports that atypical antipsychotics, such as, Clozapine may induce or worsen obsessive-compulsive symptoms, especially if given without an SSRI.
On the other hand, several studies adding atypicals such as Risperidone, Quetiapine and Olanzapine to SSRI's have resulted in improvement of Obsessive-Compulsive Disorder. In youth, these studies are all in the form of case reports and so do not yet have the support of more carefully conducted controlled trials. It appears that atypical antipsychotics have a role in the treatment of severe or treatment-resistant Obsessive-Compulsive Disorder, we remain cautious about recommending them for routine use. Further systematic research is needed to prove to what extent and for whom they can be helpful.
