What is the relationship between Obsessive-Compulsive Disorder (OCD) and treatment with Risperidone (Risperdal)?

From the Guidelines

Risperidone should only be considered as an augmentation strategy for Obsessive-Compulsive Disorder (OCD) after an adequate trial of selective serotonin reuptake inhibitors (SSRIs) has not provided sufficient relief, due to its potential side effects and smaller effect size compared to SSRIs. For OCD, SSRIs like fluoxetine, sertraline, or fluvoxamine are the recommended first-line medications, usually starting at standard doses and potentially increasing to higher doses than those used for depression 1. Risperidone, an atypical antipsychotic, may be added as an augmentation strategy at low doses (0.5-2mg daily) only after an adequate trial of SSRIs (typically 8-12 weeks) has not provided sufficient relief, as evidenced by a meta-analysis providing evidence of efficacy for both risperidone and aripiprazole augmentation 1.

Some key points to consider when using risperidone for OCD include:

• Risperidone works by blocking dopamine and serotonin receptors, which may help reduce intrusive thoughts and compulsive behaviors in some patients with treatment-resistant OCD
• Common side effects include sedation, weight gain, and metabolic changes, so regular monitoring is necessary
• Cognitive-behavioral therapy, particularly exposure and response prevention, remains an essential component of OCD treatment and should be pursued alongside medication management for optimal outcomes
• Ongoing monitoring of the risk–benefit ratio is needed in patients receiving antipsychotic augmentation of SSRIs, with particular attention on adverse events such as weight gain and metabolic dysregulation 1

It's also important to note that other augmentation strategies, such as glutamatergic medications, may be considered in clinical practice, as several trials have demonstrated their efficacy in SSRI augmentation for patients with treatment-resistant OCD 1. However, the use of risperidone as an augmentation strategy should be carefully weighed against its potential risks and benefits, and alternative strategies should be considered.

From the Research

OCD and Risperidone: Treatment Strategies

• Risperidone is an antipsychotic that has been investigated as an augmentation strategy for the treatment of obsessive-compulsive disorder (OCD) in patients who do not respond to first-line treatments 2, 3.
• Studies have shown that the addition of risperidone to serotonin reuptake inhibitors (SRIs) can be an effective strategy for treating resistant OCD, with several positive randomized controlled trials (RCTs) supporting its use 2.
• Other treatment strategies for OCD include cognitive-behavioral therapy (CBT), switch to intravenous clomipramine, switch to paroxetine or venlafaxine, and the addition of medications other than antipsychotics to SRIs 2, 4, 5.
• The efficacy of risperidone as an augmentation strategy for OCD has been compared to other antipsychotics, such as haloperidol, pimozide, paliperidone, olanzapine, quetiapine, and aripiprazole, with varying results 2.

Augmentation Strategies for OCD

• Augmentation with atypical antipsychotics, including risperidone, has been shown to be effective in patients with OCD who do not respond to monotherapy with SSRIs 3.
• Risperidone has been specifically recommended as an augmentation strategy for refractory OCD, along with olanzapine and quetiapine 3.
• The use of risperidone as an augmentation strategy for OCD has been supported by several studies, including a systematic review of evidence-based treatment strategies for OCD resistant to first-line pharmacotherapy 2.

Treatment Guidelines for OCD

• Current treatment guidelines for OCD recommend a stepped care approach, reserving combination treatment for adults with severe functional impairment or those who do not respond to first-line treatments 4.
• The use of risperidone as an augmentation strategy for OCD is supported by treatment guidelines, which recommend its use in patients who do not respond to first-line treatments 5, 3.
• Treatment guidelines also recommend the use of CBT, either alone or in combination with medication, as a first-line treatment for OCD 4.