Serotonin-norepinephrine reuptake inhibitors in the treatment of obsessive-compulsive disorder: A critical review.
ABSTRACT 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.
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.
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.
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.
- SourceAvailable from: Harumi Oshita
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- "This suggests that SSRIs and exposure therapy improve the function of the frontal and temporal lobes in OCD. SSRI has already established its efficacy in obsessive-compulsive disorder . OCD has been attributed to dysfunction in the interaction between basal ganglia and the cerebral cortex, specifically the lack of cortical control over the striatum . "
ABSTRACT: Drug therapy with selective serotonin reuptake inhibitors (SSRIs) has been used as a treatment for obsessive-compulsive disorder (OCD). In the present case report, exposure therapy was used in addition to escitalopram (20 mg) to treat a 28-year-old female patient with OCD for 6 months. Her obsessive-compulsive symptoms comprised thoughts of words such as rape, crematorium, neck hanging, unhappy, death, die, and kill and images such as a shelf of gods, a shrine, a Buddhist altar, the sun, the sky, and the faces of her parents, siblings, and relatives. As exposure therapy, she was asked to view the images associated with these symptoms three times a day along with drug therapy. With the combination of drug and exposure therapies, her obsessive-compulsive symptoms improved within 6 months, with no interference in her daily life. Multichannel near-infrared spectroscopy (NIRS) showed improvement of brain function in the temporal and frontal lobes after treatment. These results suggest that NIRS can be used as an indicator of brain function improvement in patients with OCD.09/2014; 2014:591023. DOI:10.1155/2014/591023
Different Views of Anxiety Disorders, 09/2011; , ISBN: 978-953-307-560-0
- "However, due to the absence of double-blind placebo-controlled trials, venlafaxine should not be considered a first line medication treatment for patients with OCD at this time. Perhaps venlafaxine might be considered in specific clinical situations such as OCD with comorbid attention/deficit/hyperactivity disorder (ADHD) (Dell'Osso et al., 2006). One placebo-controlled trial supports the efficacy of phenelzine (MAO inhibitor) (Vallejo et al., 1992). "
- Clinical neuropharmacology 01/2009; 32(3):174-6. DOI:10.1097/WNF.0b013e31817f8cef · 1.84 Impact Factor