Vortioxetine and Aripiprazole Combination in Treatment-Resistant Obsessive-Compulsive Disorder: A Case Report

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To the Editors
Obsessive-compulsive disorder (OCD) is a chronic and disabling disorder with a fluctuating course, and it is characterized by obsessions or compulsions that cause severe distress and interfere with the patient's functioning.1 The role of serotonin (5-HT) systems in OCD has been supported by studies reporting altered densities of the 5-HT transporter in specific cerebral regions of OCD patients, such as the right hippocampus, the left inferior temporal gyrus, and the bilateral caudate nuclei.2 Furthermore, the dopaminergic (DA) modulation of frontostriatal circuits seems to be relevant in OCD pathophysiology, and this possibly involves a change in the balance between the orbitofrontal cortex 5-HT levels and dorsal striatal DA levels.3 Moreover, a relationship between serotonin levels and glutamatergic functioning has been suggested in animal models of OCD.4
Selective serotonin reuptake inhibitors are the first-line strategy in the treatment of OCD, but approximately 40% to 60% of patients with OCD fail to respond to them and may require antipsychotic augmentation with dopamine antagonists that may enhance the therapeutic effect of selective serotonin reuptake inhibitors or other strategies.5 However, also augmentation strategies often fail, and therefore, new therapeutic options must be used.6
We will report on a case of resistant OCD who responded to a combination of vortioxetine (VRX) and aripiprazole (ARI).
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