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Double-blind study of dextroamphetamine versus caffeine augmentation for treatment-resistant obsessive-compulsive disorder.
J Clin Psychiatry. 2009 Nov; 70(11):1530-5.JC

Abstract

INTRODUCTION

Two small, double-blind, placebo-controlled, single-dose, crossover studies found dextroamphetamine (d-amphetamine) 30 mg clearly superior to placebo in relieving symptoms of obsessive-compulsive disorder (OCD). We conducted a 5-week, double-blind, caffeine-controlled study to test the hypothesis that d-amphetamine, added after an adequate selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) trial, would be more effective than caffeine in reducing residual OCD symptoms of moderate or greater severity.

METHOD

Between August 2006 and February 2008, we enrolled adults with DSM-IV OCD and a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of >or= 20 after >or= 12 weeks of adequate treatment with an SSRI or SNRI. Subjects were randomly assigned to double-blind d-amphetamine 30 mg/d or caffeine 300 mg/d added to their SSRI/SNRI and other medications. Responders (first week mean Y-BOCS score decrease of >or= 20%) entered the study's 4-week double-blind extension phase.

RESULTS

We enrolled 24 subjects, 11 women and 13 men, with a mean (SD) age of 40 (13.2) years and mean baseline Y-BOCS scores of 26.5 (4.1) for the d-amphetamine group (n = 12) and 29.1 (4.0) for the caffeine group (n = 12). At the end of week 1, 6 of 12 d-amphetamine subjects (50%) and 7 of 12 caffeine subjects (58%) were responders. At week 5, the responders' mean Y-BOCS score decreases were, for the d-amphetamine group (last observation carried forward), 48% (range, 20%-80%); and, for the caffeine group, 55% (range, 27%-89%). Obsessive-compulsive disorder and depression improvement were independent. The double-blind remained intact. No subject discontinued the study due to side effects.

CONCLUSIONS

Larger, double-blind, placebo-controlled trials of both d-amphetamine and caffeine augmentation are needed in OCD subjects inadequately responsive to adequate doses of an SSRI or SNRI.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00363298.

Authors+Show Affiliations

OCD Clinic, Stanford, CA 94305, USA. lkoran@stanford.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19573497

Citation

Koran, Lorrin M., et al. "Double-blind Study of Dextroamphetamine Versus Caffeine Augmentation for Treatment-resistant Obsessive-compulsive Disorder." The Journal of Clinical Psychiatry, vol. 70, no. 11, 2009, pp. 1530-5.
Koran LM, Aboujaoude E, Gamel NN. Double-blind study of dextroamphetamine versus caffeine augmentation for treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry. 2009;70(11):1530-5.
Koran, L. M., Aboujaoude, E., & Gamel, N. N. (2009). Double-blind study of dextroamphetamine versus caffeine augmentation for treatment-resistant obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 70(11), 1530-5. https://doi.org/10.4088/JCP.08m04605
Koran LM, Aboujaoude E, Gamel NN. Double-blind Study of Dextroamphetamine Versus Caffeine Augmentation for Treatment-resistant Obsessive-compulsive Disorder. J Clin Psychiatry. 2009;70(11):1530-5. PubMed PMID: 19573497.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Double-blind study of dextroamphetamine versus caffeine augmentation for treatment-resistant obsessive-compulsive disorder. AU - Koran,Lorrin M, AU - Aboujaoude,Elias, AU - Gamel,Nona N, Y1 - 2009/06/30/ PY - 2008/08/07/received PY - 2008/10/09/accepted PY - 2009/7/4/entrez PY - 2009/7/4/pubmed PY - 2010/1/6/medline SP - 1530 EP - 5 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 70 IS - 11 N2 - INTRODUCTION: Two small, double-blind, placebo-controlled, single-dose, crossover studies found dextroamphetamine (d-amphetamine) 30 mg clearly superior to placebo in relieving symptoms of obsessive-compulsive disorder (OCD). We conducted a 5-week, double-blind, caffeine-controlled study to test the hypothesis that d-amphetamine, added after an adequate selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) trial, would be more effective than caffeine in reducing residual OCD symptoms of moderate or greater severity. METHOD: Between August 2006 and February 2008, we enrolled adults with DSM-IV OCD and a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of >or= 20 after >or= 12 weeks of adequate treatment with an SSRI or SNRI. Subjects were randomly assigned to double-blind d-amphetamine 30 mg/d or caffeine 300 mg/d added to their SSRI/SNRI and other medications. Responders (first week mean Y-BOCS score decrease of >or= 20%) entered the study's 4-week double-blind extension phase. RESULTS: We enrolled 24 subjects, 11 women and 13 men, with a mean (SD) age of 40 (13.2) years and mean baseline Y-BOCS scores of 26.5 (4.1) for the d-amphetamine group (n = 12) and 29.1 (4.0) for the caffeine group (n = 12). At the end of week 1, 6 of 12 d-amphetamine subjects (50%) and 7 of 12 caffeine subjects (58%) were responders. At week 5, the responders' mean Y-BOCS score decreases were, for the d-amphetamine group (last observation carried forward), 48% (range, 20%-80%); and, for the caffeine group, 55% (range, 27%-89%). Obsessive-compulsive disorder and depression improvement were independent. The double-blind remained intact. No subject discontinued the study due to side effects. CONCLUSIONS: Larger, double-blind, placebo-controlled trials of both d-amphetamine and caffeine augmentation are needed in OCD subjects inadequately responsive to adequate doses of an SSRI or SNRI. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00363298. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/19573497/Double_blind_study_of_dextroamphetamine_versus_caffeine_augmentation_for_treatment_resistant_obsessive_compulsive_disorder_ L2 - http://www.psychiatrist.com/jcp/article/pages/2009/v70n11/v70n1107.aspx DB - PRIME DP - Unbound Medicine ER -