Venlafaxine in Treatment-Resistant Obsessive-Compulsive Disorder
J Clin Psychiatry 2003;64(5):546-550
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: While selective serotonin reuptake
inhibitors (SSRIs) are the first-line treatment of
obsessive-compulsive disorder (OCD), approximately 40% of
patients fail to respond to SSRIs. Venlafaxine is a
serotonin-norepinephrine reuptake inhibitor (SNRI) that might be
effective in the treatment of OCD, even among those who have
failed previous SSRI trials.
Method: Thirty-nine patients who met
DSM-IV criteria for OCD, including 29 who were resistant to prior
SRI treatment trials, were treated with venlafaxine in an open,
naturalistic fashion. Improvement was assessed using the Clinical
Global Impressions-Improvement scale.
Results: Of 39 patients treated with
venlafaxine, 27 (69.2%) were rated as sustained treatment
responders. Of the 29 patients who did not respond to 1 or more
previous SRI trials, 22 (75.9%) were rated as having sustained
response to treatment. Mean dose of venlafaxine was 232.2 mg/day
(range, 37.5-375 mg/day), and it was generally well tolerated.
Conclusion: Venlafaxine may be beneficial
to individuals with OCD, including those who have not responded
to prior SSRI trials. However, these findings must be interpreted
with caution, as the study is limited by its open, retrospective
nature and its inclusion of patients with comorbid diagnoses and
patients on concomitant medications. Prospective, controlled
trials with a more homogeneous patient population are needed to
replicate these preliminary findings.