Obsessive-Compulsive Disorder in the Postpartum

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Abstract
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. 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). 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. 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.

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