Serotonin-Norepinephrine Reuptake Inhibitors in the Treatment of Obsessive-Compulsive Disorder: A Critical Review.
J Clin Psychiatry 2006;67(4):600-610
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To critically review the
antiobsessional properties of serotonin-norepinephrine reuptake
inhibitors (SNRIs) (venlafaxine and clomipramine) in
the treatment of obsessive-compulsive disorder (OCD)
as an alternative to selective serotonin reuptake
inhibitors (SSRIs), which are currently considered the
first-line treatment of OCD.
Data Sources: A MEDLINE search was
performed to identify clinical trials with the SNRIs venlafaxine
and clomipramine published from 1996 to 2004
(keywords: SNRIs, venlafaxine, duloxetine, and
clomipramine, each matched individually with the term
OCD), focusing on the best-designed studies for inclusion.
Data Synthesis: Much of the literature about
SNRIs in OCD supports the efficacy of these compounds in
the treatment of OCD. However, double-blind,
placebo-controlled studies with venlafaxine are lacking, and
the most relevant studies consist of active comparison
trials between SNRIs and SSRIs. In these studies,
SNRIs seem to be as effective as SSRIs in OCD; SNRIs
might be preferred for patients with certain types of
treatment-resistant OCD or those with particular comorbid
conditions. A large number of placebo-controlled and
active comparison trials with clomipramine document
efficacy in OCD, and meta-analytic studies suggest a small
superiority over SSRIs. Compared with
clomipramine, the SNRI venlafaxine showed fewer side effects
and better tolerability.
Conclusion: The SNRIs may represent a valid
alternative to the SSRIs, particularly in specific
cases. Double-blind, placebo-controlled studies are,
however, needed to confirm the positive findings reported by
several studies with venlafaxine.