Is circadian rhythm disruption important in obsessive-compulsive disorder (OCD)? A case of successful augmentation with agomelatine for the treatment of OCD.

The main augmentation strategy in the treatment of obsessive-compulsive disorder (OCD) is the addition of low-dose dopamine antagonists, such as risperidone. However, the development of additional pharmacological therapeutics is necessary because some patients remain refractory to these strategies. In the present report, we describe an adult male patient with clomipramine treatment-resistant OCD who did not respond to augmentation with risperidone and aripiprazole but who showed clinical improvement with agomelatine. The effect of agomelatine in resynchronizing circadian rhythms may demonstrate the importance of the circadian rhythm disruption observed in OCD. Moreover, the regulation of the serotoninergic system is circadian in nature, and the resynchronization of the serotoninergic system may regulate serotoninergic dysfunction, a major factor in OCD.