From the Guidelines
Seroquel (quetiapine) is not a recommended treatment for obsessive-compulsive disorder (OCD) due to its inferior efficacy compared to other augmentation strategies, as evidenced by a double-blind, randomized controlled trial that found fluoxetine plus clomipramine to be significantly superior to fluoxetine plus quetiapine in reducing OCD severity 1. When considering treatment options for OCD, it's essential to prioritize evidence-based approaches that maximize efficacy while minimizing risks. The primary treatment for OCD involves selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, or fluvoxamine, often at higher doses than those used for depression.
- For patients who do not respond adequately to SSRIs alone, augmentation strategies may be considered, including the use of antipsychotics, clomipramine, or glutamatergic agents 1.
- However, the use of Seroquel (quetiapine) as an augmentation strategy is not supported by strong evidence, and its use may be associated with significant side effects, including sedation, weight gain, and metabolic changes that require monitoring.
- In contrast, the combination of SSRIs with cognitive behavioral therapy (CBT) has been shown to be an effective approach for treating OCD, with larger effect sizes compared to augmentation with antipsychotics like risperidone 1.
- Therefore, Seroquel should not be used as a first-line treatment for OCD, and its use as an augmentation strategy should be approached with caution, considering the availability of more effective and evidence-based treatment options.
From the Research
Seroquel and OCD Treatment
- Seroquel, also known as quetiapine, is an antipsychotic medication that has been studied as a potential augmentation therapy for obsessive-compulsive disorder (OCD) in patients who are resistant to serotonin reuptake inhibitors (SRIs) 2.
- A study published in 2005 found that quetiapine augmentation in OCD patients who were resistant to SRIs resulted in a significant decrease in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores in one of the two study sites, with a responder rate of 31% 2.
- Another study published in 2018 found that antipsychotic addition to SRIs, including quetiapine, was one of the effective strategies for treating treatment-resistant OCD, with 10 out of 16 randomized controlled trials (RCTs) showing positive results 3.
- However, it is essential to note that Seroquel is not a first-line treatment for OCD, and its use should be considered only in patients who have not responded to SRIs or other established treatments 3, 4, 5.
Mechanism of Action
- Quetiapine is a multi-acting receptor targeted antipsychotic (MARTA) that affects various neurotransmitter systems, including serotonin and dopamine, which may contribute to its potential efficacy in treating OCD 3, 2.
- The exact mechanism of action of quetiapine in OCD is not fully understood, but it is thought to involve the modulation of serotonin and dopamine receptors in the brain 2.
Clinical Implications
- The use of Seroquel as an augmentation therapy for OCD should be carefully considered and monitored by a healthcare professional, as it may have potential side effects and interactions with other medications 2, 6.
- Further research is needed to fully understand the efficacy and safety of quetiapine as a treatment for OCD, particularly in comparison to other antipsychotics and established treatments 3, 4, 5.