Aripiprazole Augmentation in Treatment-Resistant OCD

Introduction to Aripiprazole Augmentation

The American College of Cardiology is not relevant here, however, the International College of Obsessive-Compulsive Spectrum Disorders recommends aripiprazole as an effective augmentation strategy for treatment-resistant OCD when added to SSRIs, with evidence supporting doses of 5-15 mg/day, though it should be reserved for patients who have failed adequate trials of SSRI monotherapy and cognitive-behavioral therapy 1

Before initiating aripiprazole, ensure the patient has failed at least 8-12 weeks of maximum tolerated SSRI doses (higher than depression dosing) 1
Patients should have attempted or been offered cognitive-behavioral therapy with exposure and response prevention (ERP), which has superior efficacy to pharmacotherapy alone, as recommended by the International College of Obsessive-Compulsive Spectrum Disorders 2
The patient should have tried switching to a different SSRI or considering clomipramine if not already attempted, as suggested by treatment guidelines 1

Approximately 50% of OCD patients fail to fully respond to first-line treatments, making augmentation strategies necessary, according to the International College of Obsessive-Compulsive Spectrum Disorders 1

If effective, continue maintenance treatment for at least 12-24 months after achieving remission due to high relapse risk, as recommended by the International College of Obsessive-Compulsive Spectrum Disorders 1
Carefully weigh the risk-benefit ratio of antipsychotic augmentation, particularly regarding metabolic effects, as suggested by treatment guidelines 1
Verify that CBT with ERP has been offered, as it has larger effect sizes than pharmacotherapy, according to the International College of Obsessive-Compulsive Spectrum Disorders 2