However, as mentioned earlier, the availability of trained therapists remains an issue of concern world over, developing nations in particular. There is robust evidence to use CBT as an augmenting agent with some experts recommending that CBT is considered as a first-line augmentation strategy in those who do not show the satisfactory response to SSRIs. Augmentation refers to the process of adding treatment with a different mechanism of action to the primary drug to boost its therapeutic efficacy. Switching over to a different SSRI is recommended for those with nonresponse, while augmentation strategies are generally recommended for people with partial response. One of the major challenges in the first-line treatment of OCD with SSRIs is that only 40%–70% of patients have an adequate response the remaining experience either nonresponse or partial response. In most low- and middle-income countries, psychological services are sparse hence, in practice, pharmacological strategies are often the only available option. The first-line treatments recommended for OCD are pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) or cognitive behavior therapy (CBT) using exposure and response prevention (ERP) techniques. In many patients, OCD runs a chronic course which may worsen without treatment. Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions, with an estimated prevalence of 1%–3%. Larger studies and head-to-head trials are needed to further explore this treatment strategy. Guidelines recommend that antipsychotics be administered at a low-to-medium dosage for a duration not exceeding 3 months, with mandatory discontinuation if there is no response. Among antipsychotics, risperidone, and aripiprazole have the best evidence, with haloperidol being considered second in-line owing to its unfavorable side effect profile. The presence of comorbid tics and/or schizotypal disorder may predict a better response to antipsychotic augmentation. The findings suggest that one in three SSRI nonresponders improve with antipsychotic augmentation. In addition to case reports and case series, 15 randomized controls trials, 6 meta-analyses, and 3 expert guidelines have been examined. This article aims to review the efficacy, tolerability, and comparative efficacy of antipsychotics as augmenting agents in patients who showed inadequate response to SSRIs. The most common pharmacological strategy used in clinical practice for partial responders to SSRIs is augmentation with an atypical antipsychotic. Only 40%–70% of patients respond to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). Most studies suggest that obsessive-compulsive disorder runs a chronic course.
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