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Case Reports in Psychiatry
Volume 2013, Article ID 612459, 4 pages
http://dx.doi.org/10.1155/2013/612459
Case Report

Lamotrigine Augmentation of Serotonin Reuptake Inhibitors in Severe and Long-Term Treatment-Resistant Obsessive-Compulsive Disorder

1Department of Psychiatry, Complejo Hospitalario Universitario, 15701 Santiago de Compostela, Spain
2Servicio de Salud Mental y Asistencia a Drogodependencia Servicio Gallego de Salud, 15703 Santiago de Compostela, Spain
3Mental Health Research Center, Eastern State Hospital, Lexington, KY 40508, USA

Received 29 April 2013; Accepted 13 June 2013

Academic Editors: J. S. Brar, L. Dell'Osso, E. Jönsson, and D. L. Noordsy

Copyright © 2013 Manuel Arrojo-Romero et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The treatment recommendations in obsessive-compulsive disorder (OCD) after lack of response to selective serotonin reuptake inhibitors (SSRIs) include augmentation with other drugs, particularly clomipramine, a more potent serotonin reuptake inhibitor (SRI), or antipsychotics. We present two cases of response to lamotrigine augmentation in treatment-refractory OCD; each received multiple SRI trials over a >10-year period. The first patient had eleven years of treatment with multiple combinations including clomipramine and SSRIs. She had a >50% decrease of Y-BOCS (from 29 to 14) by augmenting paroxetine (60 mg/day) with lamotrigine (100 mg/day). The second patient had 22 years of treatment with multiple combinations, including combinations of SSRIs with clomipramine and risperidone. She had an almost 50% decrease of Y-BOCS (from 30 to 16) and disappearance of tics by augmenting clomipramine (225 mg/d) with lamotrigine (200 mg/day). These two patients were characterized by lack of response to multiple treatments, making a placebo response to lamotrigine augmentation unlikely. Prospective randomized trials in treatment-resistant OCD patients who do not respond to combinations of SSRIs with clomipramine and/or antipsychotics are needed, including augmentation with lamotrigine. Until these trials are available, our cases suggest that clinicians may consider lamotrigine augmentation in such treatment-resistant OCD patients.