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A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder.
J Clin Psychiatry. 1999 Feb; 60(2):101-6.JC

Abstract

BACKGROUND

Obsessive-compulsive disorder (OCD) is a chronic illness associated with substantial morbidity; it often requires long-term medication. The best-studied therapeutic agent in the treatment of this disorder is the tricyclic antidepressant clomipramine. Since other tricyclic antidepressants appear to lack efficacy in OCD, that of clomipramine has been linked to its potent effects on serotonin. Consequently, agents that selectively inhibit serotonin reuptake have been the focus of several large-scale, placebo-controlled studies of OCD. Their efficacy in OCD is the focus of our review.

DATA SOURCES

MEDLINE search (1966 to present) of OCD treatment with clomipramine or SSRI antidepressant medication using the key words obsessive-compulsive disorder, serotonin reuptake inhibitors, clomipramine, and pharmacology.

STUDY FINDINGS

The selective serotonin reuptake inhibitors fluoxetine, sertraline, fluvoxamine, and paroxetine have, in separate multicenter trials, demonstrated efficacy and tolerability in the treatment of OCD. In contrast, clomipramine, though efficacious, is often associated with substantial adverse events, particularly anticholinergic side effects. While 2 recent meta-analyses support the superior efficacy of clomipramine over selective serotonin reuptake inhibitors in the treatment of OCD, 5 of 6 head-to-head comparisons of either fluoxetine or fluvoxamine versus clomipramine have found similar efficacy but a lower incidence of side effects with the selective serotonin reuptake inhibitor. A recently completed multicenter, 12-week, double-blind trial of paroxetine versus clomipramine versus placebo showed paroxetine to be as effective as clomipramine. With significantly fewer dropouts due to adverse effects than clomipramine, paroxetine was also associated with superior tolerability.

CONCLUSION

The suggestion that selective serotonin reuptake inhibitors possess efficacy similar to that of clomipramine, but have a superior side effect profile, may have important implications for patients with OCD who require long-term treatment.

Authors+Show Affiliations

Clinical Therapeutics Program and Psychopharmacology Clinics, Department of Psychiatry and Behavioural Sciences, University of Texas Medical Branch, Galveston 77555-0428, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

10084636

Citation

Pigott, T A., and S M. Seay. "A Review of the Efficacy of Selective Serotonin Reuptake Inhibitors in Obsessive-compulsive Disorder." The Journal of Clinical Psychiatry, vol. 60, no. 2, 1999, pp. 101-6.
Pigott TA, Seay SM. A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder. J Clin Psychiatry. 1999;60(2):101-6.
Pigott, T. A., & Seay, S. M. (1999). A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 60(2), 101-6.
Pigott TA, Seay SM. A Review of the Efficacy of Selective Serotonin Reuptake Inhibitors in Obsessive-compulsive Disorder. J Clin Psychiatry. 1999;60(2):101-6. PubMed PMID: 10084636.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder. AU - Pigott,T A, AU - Seay,S M, PY - 1999/3/20/pubmed PY - 1999/3/20/medline PY - 1999/3/20/entrez SP - 101 EP - 6 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 60 IS - 2 N2 - BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic illness associated with substantial morbidity; it often requires long-term medication. The best-studied therapeutic agent in the treatment of this disorder is the tricyclic antidepressant clomipramine. Since other tricyclic antidepressants appear to lack efficacy in OCD, that of clomipramine has been linked to its potent effects on serotonin. Consequently, agents that selectively inhibit serotonin reuptake have been the focus of several large-scale, placebo-controlled studies of OCD. Their efficacy in OCD is the focus of our review. DATA SOURCES: MEDLINE search (1966 to present) of OCD treatment with clomipramine or SSRI antidepressant medication using the key words obsessive-compulsive disorder, serotonin reuptake inhibitors, clomipramine, and pharmacology. STUDY FINDINGS: The selective serotonin reuptake inhibitors fluoxetine, sertraline, fluvoxamine, and paroxetine have, in separate multicenter trials, demonstrated efficacy and tolerability in the treatment of OCD. In contrast, clomipramine, though efficacious, is often associated with substantial adverse events, particularly anticholinergic side effects. While 2 recent meta-analyses support the superior efficacy of clomipramine over selective serotonin reuptake inhibitors in the treatment of OCD, 5 of 6 head-to-head comparisons of either fluoxetine or fluvoxamine versus clomipramine have found similar efficacy but a lower incidence of side effects with the selective serotonin reuptake inhibitor. A recently completed multicenter, 12-week, double-blind trial of paroxetine versus clomipramine versus placebo showed paroxetine to be as effective as clomipramine. With significantly fewer dropouts due to adverse effects than clomipramine, paroxetine was also associated with superior tolerability. CONCLUSION: The suggestion that selective serotonin reuptake inhibitors possess efficacy similar to that of clomipramine, but have a superior side effect profile, may have important implications for patients with OCD who require long-term treatment. SN - 0160-6689 UR - https://www.unboundmedicine.com/medline/citation/10084636/A_review_of_the_efficacy_of_selective_serotonin_reuptake_inhibitors_in_obsessive_compulsive_disorder_ L2 - http://www.psychiatrist.com/jcp/article/pages/1999/v60n02/v60n0206.aspx DB - PRIME DP - Unbound Medicine ER -