A Multicenter Investigation of Fixed-Dose Fluoxetine in the Treatment of Obsessive-compulsive Disorder

Tollefson, Gary D.

doi:10.1001/archpsyc.1994.03950070051010

Cited by 251 publications

(103 citation statements)

References 48 publications

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“…In fact, the anti-OCD effect of SRIs generally requires a much longer delay than the antidepressant effect 30 and higher doses of SRIs are frequently necessary to obtain a clinical effect. 31,32 Blier and de Montigny 33 proposed a detailed discussion about biological mechanisms underlying the differences between the antidepressant and antiobsessive responses. In particular much evidence indicates that the anti-OCD effect, unlike the antidepressant response, is based on the inhibition of the 5-HT reuptake process.…”

Section: Discussionmentioning

confidence: 99%

Obsessive-Compulsive Disorder, 5-HTTLPR polymorphism and treatment response

et al. 2002

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Recently, a role for a functional polymorphism within the promoter region of the serotonin transporter gene (5-HTTLPR) in conferring susceptibility to Obsessive Compulsive Disorder (OCD) has been suggested. The aim of this study was to test the hypothesis that allelic variation of the 5-HTTLPR could be associated with OCD susceptibility or influence the drug response in OCD. One hundred and eighty-one OCD patients were recruited; 92 patients underwent a standardized treatment with fluvoxamine. No significant differences in allele/genotype distribution of the 5-HTTLPR were found between 191 controls and OCD. No differences in fluvoxamine response in the three genotypes groups in OCD were found, considering Yale-Brown Obsessive Compulsive Scale (YBOCS) total scores. Nevertheless, a significant time per genotype interaction was found for the YBOCS subtotal compulsion scores. Considering patients without tic disorder co-diagnosis, a significant time per genotype interaction for both YBOCS total scores and compulsion scores was found

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Section: Discussionmentioning

confidence: 99%

Obsessive-Compulsive Disorder, 5-HTTLPR polymorphism and treatment response

et al. 2002

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“…In the treatment of children and adolescents, the efficacy of fluvoxamine could also be shown in DBPC studies (Riddle et al 1996(Riddle et al , 2001) (A). Á Fluoxetine was superior to placebo in doubleblind studies Tollefson et al 1994;Zitterl et al 1999). In a comparison with clomipramine, efficacy for both drugs was comparable, with a minor advantage for clomipramine (Lopez-Ibor et al 1996).…”

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

“…As a rule, higher doses of the antidepressants are used in OCD, as compared with other anxiety disorders or major depression. Fixed-dose comparator studies provide inconsistent evidence for a doseÁ response relationship with SSRIs, higher doses being associated with greater efficacy in most Montgomery et al 1993;Romano et al 2001;Stein et al 2007b) but not all evaluations (Greist et al 1995b;Tollefson et al 1994). In the study by Montgomery et al higher doses of citalopram were more efficacious on secondary but not primary efficacy measures (Montgomery et al 2001).…”

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

712

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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“…For instance, there is some similarity between the repetitive behaviors seen in autism and behaviors seen in obsessive-compulsive disorder. Selective serotonin reuptake inhibitors (SSRIs), which improve repetitive behaviors in obsessive-compulsive disorder (Tollefson et al, 1994;Greist et al, 1995;Clomipramine Collaborative Study Group, 1991;Hollander et al, 2003a) might also be utilized to target this symptom domain in autism. However, whether or not the repetitive/stereotypic behaviors associated with autism represent a similar behavioral dimension to the compulsive symptoms of OCD is still uncertain.…”

Section: Introductionmentioning

confidence: 99%

A Placebo Controlled Crossover Trial of Liquid Fluoxetine on Repetitive Behaviors in Childhood and Adolescent Autism

Hollander

Phillips

Chaplin

et al. 2004

Neuropsychopharmacol

344

214

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Repetitive behaviors are a core symptom domain in autism that has been linked to alterations in the serotonin system. While the selective serotonin-receptive inhibitor fluvoxamine has been shown to be effective in adults with autism, as yet no published placebo controlled trials with these agents document safety and efficacy in children with autism. This study examines the selective serotonin reuptake inhibitor liquid fluoxetine in the treatment of repetitive behaviors in childhood and adolescent autism spectrum disorders (ASDs). In total, 45 child or adolescent patients with ASD were randomized into two acute 8-week phases in a double-blind placebocontrolled crossover study of liquid fluoxetine. Study design included two randomized 8-week fluoxetine and placebo phases separated by a 4-week washout phase. Outcome measures included measures of repetitive behaviors and global improvement. Low-dose liquid fluoxetine (mean final dose: 9.974.35 mg/day) was superior to placebo in the treatment of repetitive behaviors by CY-BOCS compulsion scale. The effect size was in the moderate to large range, and the doses used were low. Liquid fluoxetine was only slightly, and not significantly, superior to placebo on CGI autism score partially due to a phase order effect. However, fluoxetine was marginally superior to placebo on a composite measure of global effectiveness. Liquid fluoxetine did not significantly differ from placebo on treatment emergent side effects. Liquid fluoxetine in low doses is more effective than placebo in the treatment of repetitive behaviors in childhood autism. Limitations include small sample size and the crossover design of the study. Further replication and long-term maintenance trials are needed.

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A Multicenter Investigation of Fixed-Dose Fluoxetine in the Treatment of Obsessive-compulsive Disorder

Abstract: Fluoxetine was associated with a statistically significant reduction in OCD severity, including time engaged in obsessional and/or compulsive behaviors. Adverse events infrequently led to study discontinuation.

Cited by 251 publications

References 48 publications

Obsessive-Compulsive Disorder, 5-HTTLPR polymorphism and treatment response

Obsessive-Compulsive Disorder, 5-HTTLPR polymorphism and treatment response

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

A Placebo Controlled Crossover Trial of Liquid Fluoxetine on Repetitive Behaviors in Childhood and Adolescent Autism

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