29 - References

References

592 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 5 References

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12. Pellegrini L, et al. Suicidality in patients with obsessive-­compulsive and related disorders (OCRDs): a meta-­analysis. Compr Psychiatry 2021; 108:152246. Table 5.9  Treatments of OCD used in adults that may be effective in children. Treatment Comment Topiramate augmentation of SSRI Case studies suggest this may be beneficial and one RCT showed an effect for compulsions but not obsessions.37,38 Other trials have not found it to be effective.39 Not to be used in female adolescents. High-­dose SSRI (with ECG monitoring) Higher than licensed maximum dose SSRI associated with clinical improvement and well tolerated in a retrospective case note survey, double-­blind trial and open-­label ­study­­40–42 SNRIs Duloxetine shown to be as effective as sertraline in a small RCT, and an open-­label trial suggested it could reduce symptoms of OCD43,44 Mirtazapine Superior to placebo in an open trial45 Pregabalin Augmentation of sertraline was more effective than augmentation with placebo.46 5HT3 antagonists Ondansetron is effective as add-­on treatment.47 Note risk of QT prolongation Ketamine IV Case report showed rapid resolution of symptoms48 Tolcapone (catechol-Omethyltransferase inhibitor) One small trial showed benefit over placebo.49 Methylphenidate Small study showed some benefit for OCD in combination with fluvoxamine50 Deep brain stimulation Could be effective treatment for resistant OCD.51 Transcranial magnetic stimulation (TMS) Meta-­analysis showed that TMS can reduce the severity of OCD.52

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