Mirtazapine for Obsessive-Compulsive Disorder: An Open Trial Followed by Double-Blind Discontinuation
J Clin Psychiatry 2005;66(4):515-520
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Many patients with
obsessive-compulsive disorder (OCD) experience little response to
standard treatment with serotonin reuptake inhibitors.
Mirtazapine enhances serotonergic function by a mechanism
distinct from reuptake inhibition. Because a pilot study
suggested effectiveness of mirtazapine in OCD, we conducted a
Method: We recruited 30 subjects, 15
treatment-naive and 15 treatment-experienced, with DSM-IV OCD of
> = 1 year's duration and a Yale-Brown Obsessive Compulsive
Scale (YBOCS) score of > = 20. In the 12-week, open-label phase,
subjects received mirtazapine starting at 30 mg/day and titrated
over 2 weeks as tolerated to 60 mg/day. At week 12, responders
(YBOCS score decrease > 25%) were randomly assigned,
double-blind, to continue mirtazapine or switch to placebo for 8
weeks, including a 1-week, double-blind taper week for placebo
Results: In the open-label phase, the mean ± SD YBOCS score fell from 28.3 ± 3.7 to 20.3 ± 8.5 (paired samples
t = 4.81, p < .0001). Four subjects (13.3%) discontinued for side
effects. Sixteen subjects (53.3%) (8 treatment-naive, 8
treatment-experienced) were responders and 15 agreed to
randomization. Response was independent of comorbid mood
disorders. In the 8-week, double-blind, placebo-controlled
discontinuation phase, the mirtazapine group's mean YBOCS score
fell a mean ± SD of 2.6 ± 8.7 points while the placebo group's mean
score rose a mean ± SD of 9.1 ± 7.5 points (Mann Whitney U = 6.5,
p = .005, 1-tailed). All other outcome measures were consistent
with mirtazapine's superiority versus placebo.
Conclusion: Mirtazapine may be an effective
pharmacotherapy for OCD. If our results are replicated, larger
double-blind studies would be indicated.