A recent review from the University of British Columbia and elsewhere found the use of clozapine, an antipsychotic drug, linked to higher risks of obsessions and compulsions.
The study is published in Psychotherapy and Psychosomatics. The lead author is Kim, D.D. from the University of British Columbia.
It is not uncommon to find obsessive-compulsive symptoms (OCS) in patients treated with clozapine. These symptoms are attributed to the anti-serotonergic effects of clozapine.
The aim of this study was to do a systematic review of reported cases of clozapine-associated OCS to better understand the nature and management of these symptoms.
The team found 57 studies reporting cases of clozapine-associated OCS.
Results showed that clozapine triggered moderate-severe OCS at varying doses (100–900 mg/day) and treatment durations (median six months, interquartile range two to 24 months).
Higher severity was strongly linked to preexisting OCS, poorer insight into OCS, and active psychosis at the time of OCS.
Common strategies to treat clozapine-associated OCS included adding selective serotonin reuptake inhibitors, clomipramine, or aripiprazole, often accompanied by clozapine dose reduction.
The rate of response to antidepressants was 49%, where younger age, shorter duration of an underlying illness, shorter clozapine treatment duration, better insight into OCS, and presence of taboo thoughts were significantly associated with antidepressant response.
Subsequent clozapine dose reduction was effective in many non-responders, where aripiprazole was simultaneously added in 50%.
These findings suggest that clozapine can trigger severe OCS. Adding aripiprazole with/without clozapine dose reduction may be a good alternative to antidepressants for managing clozapine-associated OCS.
The team says clinicians should be more vigilant about these adverse effects and administer appropriate treatments.
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