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In their recent article, McDougle et al¹ concluded that patients with obsessive-compulsive disorder (OCD) refractory to serotonin reuptake inhibitor (SRI) monotherapy may respond to a mean ± SD low dose of risperidone (2.2 ± 0.7 mg) added to SRI treatment. However, the observed relationship between low doses of risperidone and its antiobsessional effect needs further evaluation.

Positron emission tomography studies have shown that risperidone, even at low doses (2 mg), exhibits a high occupancy of serotonin, (5-HT₂) receptors (80%), while a moderate dose (2-6 mg) is required to induce 66% to 80% of dopamine type 2 (D₂) occupancy.² Dopamine type 2 antagonists such as pimozide and haloperidol seem to augment the efficacy of SRIs in refractory OCD with tics and schizotypal disorder,^3-4 suggesting that dopamine D₂ antagonism in combination with serotonin reuptake inhibition may enhance their therapeutic efficacy for OCD. Taking into account that D₂ antagonism . . . [Full Text of this Article]