title: Buprenorphine augmentation in the treatment of refractory obsessive-compulsive disorder.
abstract: BACKGROUND
  OCD is often refractory to treatment. There is a need for the development of new, non-invasive treatments for severe OCD.
  
  
  BACKGROUND
  There is evidence that opiates can be a useful adjunctive treatment in OCD. We summarise our experience with sublingual buprenorphine augmentation of standard pharmacological management of severe OCD.
  
  
  METHODS
  Patients were recruited from a standard psychiatric outpatient clinic and gave their consent to the treatment trial. The severity of the OCD was rated with the Y-BOCS. The buprenorphine was introduced to their existing medication regime at a low dose and the dose increased according to response. In order to gauge the reproducibility of the response the buprenorphine was withdrawn and then reintroduced once symptoms had returned.
  
  
  RESULTS
  4 out of 7 patients with treatment resistant OCD showed a 30% reduction in the Y-BOCS score following buprenorphine augmentation. 3 of the responders were comorbid for other Axis 1 diagnoses. All of the responders had shown some improvement with SSRIs or clomipramine. Non-responders had not shown any improvement with either antidepressant or antipsychotic drugs. Typically improvement appeared within 2 days of initiating buprenorphine and waned within 1 to 2 days of its discontinuation. The dose of buprenorphine required varied between 400 µg and 600 µg a day. One responder managed on alternate day dosing. Reintroduction of buprenorphine resulted in symptom control within 2 to 3 days. The buprenorphine treatment was not associated with significant side-effects and the improvement was maintained without progressive dose escalation.
  
  
  CONCLUSIONS
  Buprenorphine augmentation of standard treatment for OCD can result in clinically meaningful improvement in a proportion of refractory OCD cases. Further treatment trials are indicated.
authors: Adult Community Mental Health Services, DHHS NW Tasmania, 1 Parkside, Burnie, Tasmania 7320, Australia.
authors: Malcolm B
authors: MB
authors: Liddell
authors: Victor
authors: V
authors: Aziz
authors: Patrick
authors: P
authors: Briggs
authors: Nimalee
authors: N
authors: Kanakkehewa
authors: Omar
authors: O
authors: Rawi
keywords: buprenorphine; obsessive–compulsive disorder; treatment
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