Article Type: Case Reports
Early-term Aripiprazole Augmentation and Clinical Efficacy in Treatment of Pediatric OCD: A Case Series of Six Adolescents
Ferhat Yaylaci, Handan Ozek Erkuran, Murat Eyuboglu

Obsessive- compulsive disorder (OCD) in childhood is characterized by intrusive thoughts and compulsions causing significant levels of distress and functional deterioration. Guidelines for OCD treatment recommend Cognitive- Behavioral Therapy (CBT) as first line treatment choice, best efficient when practiced along with family counseling and psychoeducation. Selective serotonin Reuptake Inhibitors (SSRI) have long been successfully used in the treatment of OCD. Therapy with multiple drugs and augmentation strategies have only been proposed for cases with treatment resistance. The term “treatment-resistance” reflects presence of persistent and severe OCD symptoms even though efficient and recommended line of treatment strategies have been used at therapeutic doses for recommended period. This might indicate clinical unresponsiveness following the use of at least two different SSRIs or one SSRI and clomipramine, accompanied by sufficient number of CBT sessions. Many drugs have been tried for augmentation, in the face of treatment-resistance. However, such drug trials mainly have been conducted with adult samples, and studies that assess augmentation in children and adolescents have been scarce. Some of these have focused on aripiprazole as a fine alternative to be used for augmentation. This series comprises clinical course and treatment of six adolescents diagnosed with OCD from three different centers in Turkey, who had all responded well to early on- augmentation treatment with aripiprazole, indicating the possible need to further discuss the given issue.


1.Piacentini J, Bergman RL, Keller M, McCracken J. Functional impairment in children and adolescents with obsessive compulsive disorder. J Child Adolesc Psychopharmacol 2003;13(Suppl.1):61-9.

2.Valderhaug R,Ivarsson T. Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive- compulsive disorder. Eur Child Adolesc Psychiatry 2005;14(3):164-73.

3.Geller DA. Obsessive compulsive and spectrum disorders in children and adolescents. Psychiatr Clin North Am 2006;29(2):353-70.

4.March JS, Mulle K. OCD in Children and Adolescents: A Cognitive Behavioral Treatment Manual. New York, NY: The Guilford Press, 1998.

5.Watson HJ, Rees CS. Meta- analysis of randomized controlled treatment trials for pediatric obsessive compulsive disorder. J Child Psychol Psychiatry 2008;49(5):489-98.

6.Ivarsson T, Skarphedinsson G, Kornor H, Axelsdottir B, Biedile S, Heyman I, et al. The place of and evidence for serotonin reuptake inhibitors (SRIs) for obsessive compulsive disorder (OCD) in children and adolescents: Views based on a systematic review and meta-analysis. Psychiatry Res 2015;227(1):93-103.

7.Mancuso E, Faro A, Joshi G, Geller DA. Treatment of pediatric obsessive compulsive disorder: a review. J Child Adolesc Psychopharmacol 2010;20(4):299-308.

8.Krebs G, Heyman I. Treatment- resistant obsessive compulsive disorder in young people: Assessment and Treatment Strategies. Child Adolesc Ment Health 2010;15(1):2-11.

9.Grados MA, Riddle MA. Pharmacologic treatment of childhood obsessive- compulsive disorder: from theory to practice. J Clin Child Psychol 2001;30(1):67-79.

10.McDougle CJ, Goodman WK, Leckman JF, Lee NC, Heninger GR, Price LH. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry 1994;51(4):302-8.

11.Masi G, Pfanner C, Brovedani P. Antipsychotic augmentation of selective serotonin reuptake inhibitors in resistant tic-related obsessive-compulsive disorder in children and adolescents: a naturalistic comparative study. J Psychiatr Res 2013;47(8):1007-12.

12. Murphy TK, Mutch PJ, Reid JM, Edge PJ, Storch EA, Bengtson M, et al. Open label aripiprazole in the treatment of youth with tic disorders. J Child Adolesc Psychopharmacol 2009;19(4):441-7.

13.Goodwin G, Fleischhacker W, Arango C, Baumann P, Davidson M, de Hert M, et al. Advantages and disadvantages of combination treatment with antipsychotics ECNP Consensus Meeting, March 2008, Nice. Eur Neuropsychopharmacol 2009;19(7):520-32.

14.Pallanti S, Quercioli L, Bruscoli M. Response acceleration with mirtazapine augmentation of citalopram in obsessive-compulsive disorder patients without comorbid depression: a pilot study. J Clin Psychiatry 2004;65(10):1394-9.

15.Masi G, Pfanner C, Millepiedi S, Berloffa S. Aripiprazole augmentation in 39 adolescents with medication- resistant obsessive compulsive disorder. J Clin Psychopharmacol 2010;30(6):688- 93.

16.Fitzgerald KD, Stewart CM, Tawile V, Rosenberg DR. Risperidone augmentation of serotonin reuptake inhibitors in pediatric obsessive compulsive disorder. J Child Adolesc Psychopharmacol 1999;9(2):115-23.

17.Thomsen PH. Risperidone augmentation in the treatment of severe adolescent OCD in SSRI- refractory cases: a case series. Ann Clin Psychiatry 2004;16(4):201-7.

18.Storch EA, Lehmkuhl H, Geffken GR, Touchton A, Murphy TK. Aripiprazole augmentation of incomplete treatment response in an adolescent male with obsessive- compulsive disorder. Depress Anxiety 2008;25(2):172-4.

19.Ulay HT. Aripiprazole for Obsessive Compulsive Disorder in Children and Adolescents: Case Reports. Turk J Child Adolesc Ment Health 2010; 17 (2): 91-6.

20.Akyol Ardic U, Ercan ES, Kutlu A, Yuce D, Ipci M, Inci SB. Successful Treatment Response with Aripiprazole Augmentation of SSRIs in Refractory Obsessive Compulsive Disorder in Childhood. Child Psychiatry Hum Dev 2017;48(5):699-704.

21.Ercan ES, Ardic UA, Ercan E, Yuce D, Durak S. Promising Preliminary Study of Aripiprazole for Treatment- Resistant Childhood Obsessive- Compulsive Disorder. J Child Adolesc Psychopharmacol 2015;25(7):580-4.

22.Tadori Y, Miwa T, Tottori K, Burris KD, Stark A, Mori T, et al. Aripiprazole’s low intrinsic activities at human dopamine D2L and D2S receptors render it a unique antipsychotic. Eur J Pharmacol 2005;515(1–3):10–9.

23.Kalra SK, Swedo SE. Children with obsessive-compulsive disorder: are they just “little adults”? J Clin Invest 2009;119(4): 737–46.

24.DeLeon A, Patel NC, Crismon ML. Aripiprazole: a comprehensive review of its pharmacology, clinical efficacy, and tolerability. Clin Ther 2004;26(5):649-66.

Key words: Aripiprazole, augmentation, children, obsessive-compulsive disorder, psychopharmacology
Psychiatry and Behavioral Sciences 2019;9(4):179-187
Online ISSN: 2636-834X
Creative Commons License This work is licensed under a Creative Commons Attribution 3.0 Unported License