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Donepezil as Add-on Treatment for Resistant Obsessive-Compulsive Disorder: Retrospective Case Series

Bergman, Joseph MD; Miodownik, Chanoch MD; Lerner, Paul P. MD; Miodownik, Einat PhD; Shulkin, Alexander MD; Lerner, Vladimir MD, PhD

doi: 10.1097/WNF.0000000000000160
Original Articles

Obsessive-compulsive disorder (OCD) is one of the most common and disabling psychiatric disorders. Treatment with serotonin selective reuptake inhibitors (SSRIs) shows significant improvement; however, residual symptoms remain in most patients despite continued adequate OCD treatment. For patients exhibiting partial or no response to multiple SSRIs, augmentation strategies are usually recommended. Here, we introduce a retrospective consecutive sample of aged patients with resistant OCD treated with donepezil augmentation to regular pharmacotherapy.

Methods Ten patients (5 males, 5 females; mean [SD] age, 63.8 [7.5] years), suffering from resistant OCD, were openly treated with donepezil 10 mg/d as add-on. Efficacy was assessed at baseline and after 8 weeks of treatment using the Yale-Brown Obsessive Compulsive Scale, Clinical Global Impression-Severity, and Clinical Global Impression-Improvement.

Results The treatment was generally well tolerated without adverse events. In all patients, mean (SD) Yale-Brown Obsessive Compulsive Scale scores diminished from 27.3 (4.3) points at baseline to 16.9 (4.5) points at week 8 (P < 0.0001). Mean (SD) Clinical Global Impression-Severity scores diminished from 5.5 (0.7) points to 3.1 (1.0) points, (P < 0.001). According to Clinical Global Impression-Improvement, 7 patients demonstrated “very much” or “much” improvement and 3 patients did not demonstrate any improvement.

Conclusions Donepezil was a well-tolerated add-on to regular pharmacotherapy in treatment-resistant OCD patients in this small cases series. Donepezil could be a promising optional therapy for patients suffering from resistant OCD, but further randomized controlled studies are necessary.

*Mental Health Center Tirat Carmel, Bruce Rappaport Faculty of Medicine Technion, Haifa; †Be'er-Sheva Mental Health Center, Faculty of Health Sciences Ben-Gurion University of the Negev, Be'er-Sheva; ‡Faculty of Medicine, Bar-Ilan University, Tsfat; and §Hemdat HaDarom, Academic College of Education, Netivot, Israel.

Address correspondence and reprint requests to Vladimir Lerner, MD, PhD, Be'er-Sheva Mental Health Center, PO Box 4600, Be'er-Sheva, 84170, Israel; E-mail:

Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare.

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