Dopamine Modulation in OCD: The Role of Antipsychotics in Treatment-Resistant Cases

• DOI: https://doi.org/10.22533/at.ed.1594932415104

• Palavras-chave: Antipsychotic augmentation; Obsessive-compulsive disorder; Treatment-resistant OCD; Risperidone in OCD; Dopamine modulation.

• Keywords: Antipsychotic augmentation; Obsessive-compulsive disorder; Treatment-resistant OCD; Risperidone in OCD; Dopamine modulation.

• Abstract: INTRODUCTION The introduction highlights the limitations of current first-line treatments for Obsessive-Compulsive Disorder (OCD), such as SSRIs and cognitive behavioral therapy, in addressing treatment-resistant cases. It discusses the rationale for using antipsychotics as augmentation therapy in these cases, focusing on the dual modulation of serotonin and dopamine systems. Atypical antipsychotics like risperidone and aripiprazole are examined in terms of their mechanisms and benefits for patients who do not respond adequately to SSRIs alone. OBJETIVE To explore the clinical efficacy, safety, and neurobiological mechanisms of antipsychotic augmentation in treatment-resistant OCD patients, particularly in combination with SSRIs METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Obsessive-Compulsive Disorder (OCD)” AND “Antipsychotic augmentation” AND “Serotonin-dopamine modulation” OR “Treatment-resistant OCD” AND “Pharmacological strategies in OCD” in the last  years. RESULTS AND DISCUSSION The discussion explores the clinical evidence supporting antipsychotic augmentation, showing significant improvements in treatment-resistant OCD patients when low-dose antipsychotics are combined with SSRIs. The role of dopamine antagonism and serotonin modulation in reducing compulsive behaviors is analyzed. Additionally, the side effect profiles of atypical antipsychotics, such as weight gain, metabolic syndrome, and cognitive impairment, are discussed, emphasizing the need for careful patient monitoring. The paradox of antipsychotic monotherapy exacerbating obsessive symptoms while being effective in combination with SSRIs is also reviewed. Long-term considerations, such as relapse risk and strategies for tapering medications, are critically examined. CONCLUSION The conclusion emphasizes the importance of antipsychotic augmentation in managing treatment-resistant OCD, acknowledging the balance between efficacy and side effect management. While the combination of antipsychotics and SSRIs has shown promise, careful monitoring and individualized treatment approaches are essential to mitigate risks. The need for continued research into the neurobiological mechanisms and long-term safety of antipsychotic therapy is highlighted, along with the potential for future innovations in OCD treatment.