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Topiramate (1000 mg) Abuse for Weight Loss in an Adolescent With Anorexia Nervosa.

in case of nonresponse or intolerance in young subjects with OCD, we preferred aripiprazole rather than a different SSRI. There could be several reasons for this preference. First of all, we thought that both subjects may develop similar adverse effects with another SSRI as they may require relatively higher dosage that increases the risk to develop either behavioral activation or amotivational/apathy symptoms. Second important point could be unique pharmacological actions of aripiprazole. Data from several studies in the literature as well as authors' clinical experience may have prompted aripiprazole use in these subjects. Aripiprazole acts as a partial agonist on dopamine (D2, D3) and 5-HT1A receptors and as an antagonist on 5-HT2A receptors. Because of the effect as partial agonist on 5-HT1-A receptors, it is assumed to have anti-OCD properties. There have been several studies reporting efficacy of aripiprazole augmentation or monotherapy in young subjects with OCD. We expected that aripiprazole would be effective treating OCD in these subjects without causing behavioral activation or amotivation/apathy symptoms. As expected, low dose of aripiprazole was effective in treating OCD and several behavioral and amotivatonal/apathy symptoms in these young subjects without causing any significant adverse effects. In a recent study, first author reported a 44-month-old boy with multiple diagnoses including severe and distressing symptoms of OCD. This young subject developedmaniawhile treatment with escitalopram and risperidone. His OCD and other behavioral problems were then treated successfully and safely with aripiprazole monotherapy. Obsessive compulsive disorder and ADHD are a frequent diagnosis in clinical samples among children that may show high rates of bidirectional comorbidity. Attention-deficit/ hyperactivity disorder has been reported as a possible risk factor to develop behavioral adverse effects with SSRIs particularly in children. Meanwhile, antipsychotics such as aripiprazole have been reported to be effective in treating ADHD symptoms in children, and several antipsychotics have been reported useful in ameliorating amotivational symptoms induced by SSRIs. Aripiprazole, therefore, was expected and was helpful in reducing behavioral and amotivatonal symptoms in these young subjects. Depending on the data from recent studies and our clinical experience, it can be suggested that aripiprazole may be a choice of psychopharmacological treatment in young subjects with OCDwho cannot tolerate SSRIs or comorbid with behavioral disorders. AUTHOR DISCLOSURE INFORMATION The authors transfer all copyright ownership of the manuscript entitled “Aripiprazole Treatment for Obsessive Compulsive Disorder in 2 Young Subjects Who Could Not Tolerate SSRIs” to the Journal of Clinical Psychopharmacology. The authors warrant that the article is original, is not for consideration by another journal, has not been previously published, and has been prepared according to the manuscript rules. The authors declare no conflicts of interest.