Obsessive-Compulsive Disorder in the Postpartum

OBJECTIVE: Postpartum nonpsychotic conditions are routinely treated with antidepressant therapy. However, a subset of this population with comorbid obsessive-compulsive disorder (OCD) is treatment-resistant. Optimal response is obtained by augmentation therapy with novel antipsychotics. The objective of this open-label study was to evaluate clinical response to quetiapine augmentation of SSRIs or SNRIs in treatment-resistant OCD in the postpartum. METHODS: Twenty-two postpartum women diagnosed with OCD as per DSM-IV criteria, who did not respond to at least 8 weeks of SSRI or SNRI monotherapy, were offered a trial of quetiapine augmentation for 12 weeks. Response (defined as >50% reduction in scores) was assessed using the Yale Brown Obsessive-Compulsive Scale (YBOCS) and Clinical Global Impressions scale (CGI). RESULTS: Seventeen patients agreed to a trial of quetiapine augmentation. Three withdrew early due to side effects, and 14 completed the 12-week trial. Of these, 11 responded to treatment within 12 weeks, with a mean (SD) response time of 5.9 (2.6) weeks. The mean (SD) baseline YBOCS score of 24.7 (6.8) dropped to a mean of 10.3 (9.0), with a mean reduction of 59.6%. Mean CGI scores at outcome were 1.9 (1.2). The average dose of response was 112.5 mg (76.4 mg). Sedation was the most commonly reported side effect. CONCLUSIONS: Although limited by lack of controls, this is the first study in a postpartum population where the addition of quetiapine to antidepressant therapy has been shown to be effective for treatment-refractory OCD. Quetiapine deserves further controlled study in this context.