Venlafaxine augmentation with agomelatine in a patient with obsessive-compulsive disorder and suicidal behaviors

Abstract

Obsessive-compulsive disorder is a chronic and disabling condition that often proves to be treatment resistant. Of the patients suffering from obsessive-compulsive disorder, 10%–27% may attempt suicide at least once in their life. We report the case of a patient who presented severe obsessive-compulsive disorder symptoms and attempted suicide ingesting 25 tablets of fluoxetine (20 mg). The patient was treated with venlafaxine and agomelatine and showed improvement of obsessive symptoms and suicidal ideation. Future studies are needed to investigate this treatment regime in large cohorts of obsessive-compulsive disorder patients with suicidal ideation.

What combinations of agomelatine with other antidepressants could be successful during the treatment of major depressive disorder or anxiety disorders in clinical practice?

“…23 Another patient with OCD, who was treated with 300 mg of venlafaxine and 25 mg of agomelatine, also showed improvement of symptoms and fewer episodes of suicidal ideation. 24…”

“…In addition, a reduction in escitalopram to 20 mg daily was also possible. 22 In a male patient, the addition of agomelatine 25 mg/day to escitalopram 10 mg/day resulted in a remarkable Two 27,28 Two 23,24 N/A One 26…”

“…20,21 Recently, several articles were published about patients that had achieved remission of their mental illness after combining agomelatine with standard antidepressants like escitalopram, venlafaxine, and other anti-depressive drugs. [22][23][24][25][26] Conversely, there are publications available on agomelatine combinations with duloxetine that describe the development of serious adverse events. 27,28 In summary, the main therapeutic advantages or disadvantages of agomelatine combinations with other antidepressants, and full texts of published articles found on PubMed were analyzed from a pharmacological point of view.…”

Etiopathology and neurobiology of obsessive-compulsive disorder: focus on biological rhythms and chronotherapy

“…108 When added to classical pharmacological agents used for OCD (eg, escitalopram, venlafaxine, clomipramine, risperidone, and/or aripiprazole), agomelatine has been found to improve OC symptoms in several cases of treatment-resistant OCD. [109][110][111] In some cases, this led to full remission after ∼3 months of treatment, 109 and in reports with longitudinal monitoring, clinical improvements were often sustained over several months. 110,111 A multiple case study reported considerable clinical improvements in three out of six cases of treatment-resistant OCD.…”

“…[109][110][111] In some cases, this led to full remission after ∼3 months of treatment, 109 and in reports with longitudinal monitoring, clinical improvements were often sustained over several months. 110,111 A multiple case study reported considerable clinical improvements in three out of six cases of treatment-resistant OCD. 112 Interestingly, two of the three individuals who responded to agomelatine initially presented with sleep disruptions.…”