Efficacy of Drug Treatment in Obsessive—Compulsive Disorder

Background.A review of the efficacy of antidepressantdrug treatment in patients with obsessive—compulsive disorder(OCD), usinga meta-analyticapproach. Method. Randomiseddouble-blindclinicaltrialsof antidepressantdrugs,carriedout among patients with OCD and publishedin peer-reviewedjournalsbetween 1975 and May 1994, were selectedtogetherwith three studiescurrentlyin press.Forty-seventrialswere located by searchingthe MedlineandExcerptaMedica—¿ Psychiatrydata bases,scanningpsychiatric andpsychopharmacological journals,consultingrecentpublishedreviewsandbibliographies, contactingpharmaceutical companiesandthroughcross-references. Hedges'g was computed in pooleddata at the conclusionof treatment underdouble-blindconditionsor at the latest reportedpointof timeduringthistreatmentperiod.Foreachtrial, effect sizeswere computed for allavailableoutcomemeasuresof the followingdependentvariables:obsessive—compulsive symptomsconsideredtogether;obsessions; compulsions; depression;anxiety;globalclinical improvement;psychosocialadjustment;and physicalsymptoms. Results.Clomipramine was superior to placeboinreducingbothobsessive-compulsive symptoms consideredtogether(g= 1.31; 95% Cl= 1.l5to 1.47) as well asobsessions(g=0.89, 95% Cl= 0.36 to 1.42) andcompulsionstg= 0.79; 95% Cl= 0.34 to 1.24) takenseparately.Also, selectiveserotoninre-uptakeinhibitors(SSRIs)asa classwere superiorto placebo,weighted meang beingrespectively0.47 (95% Cl= 0.33 to 0.61), 0.54 (95% Cl= 0.34 to 0.74) and 0.52 (95% Cl= 0.34 to 0.70) for obsessive—compulsive symptomsconsideredtogether,and obsessionsandcompulsions takenseparately. AlthoughonY-BOCSthe increasein improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine,fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine andfluvoxamineprovedsuperior to antidepressant drugswithnoselectiveserotonergic properties. Conclusion. Antidepressant drugsareeffectiveinthe short-termtreatmentof patientssuffering from OCD; although the increase in improvement rate over placebo was greater for clomipraminethan for SSRIs,directcomparisonbetweenthesedrugsshowedthat they had similartherapeuticefficacyonobsessive-compulsive symptoms;clomipramineandfluvoxamine had greater therapeuticefficacy than antidepressantdrugs with no selectiveserotonergic properties;concomitanthigh levelsof depressionat the outset did not seem necessaryfor clomipramineand for SSRIsto improveobsessive—compulsive symptoms.