Acute and Long-Term Treatment and Prevention of Relapse of Obsessive-Compulsive Disorder With Paroxetine

Abstract

Paroxetine doses of 40 mg/day and 60 mg/day (but not 20 mg/day) are effective in treating acute obsessive-compulsive disorder. Long-term treatment with paroxetine is effective and safe, decreases the rate of relapse, and lengthens the time to relapse.

Standard criteria for relapse are needed in obsessive-compulsive disorder

“…Other Return to Week 0 Y-BOCS or CGI-S Z1 above Week 12 CGI-S [Hollander et al, 2003] .722 .21, .650…”

“…Koran et al [2002] found that sertraline (SERT) responders rarely relapsed over 28 weeks whether they were maintained on SERT (3/108; 3%) or switched over 2 weeks to PBO (5/113; 4%); relapse was defined as a Y-BOCS increase of at least five points, a total Y-BOCS score of at least 20, and at least a one-point increase on the CGI-I scale relative to the end of acute treatment at three consecutive visits at 2-week intervals. Finally, Hollander et al [2003] found that paroxetine (PAR) responders maintained on PAR for 6 months, compared to those switched immediately to placebo, had a significantly lower relapse rate (37.7 versus 58.8%) and longer time to relapse (62.9 versus 28.5 days); relapse was defined as a return to the pretreatment Y-BOCS score or an increase of at least one point on the CGI-severity (CGI-S) scale [Guy, 1976] relative to the end of treatment. In sum, using different SRIs, different study designs, and different relapse criteria, double-blind discontinuation studies found SRI relapse rates to range from a low of 4% over 28 weeks ] to a high of 89% over 7 weeks [Pato et al, 1988].…”

“…Conversely, when relapse was defined as a Y-BOCS Z16 in those whose posttreatment Y-BOCS score waso16 [Eisen et al, 1999], responders with Week 12 Y-BOCS scores closest to 16 (CMI patients in this dataset) were more likely to meet relapse criteria. For example, a CMI patient with a Week 12 Y-BOCS score of 12 (the group average) would be designated a relapser with only a four-point Y-BOCS increase; an EX/RP or EX/RPþCMI patient with a Week 12 [Foa and Kozak, 1996] 6 (55) 1 (6) 3 (20) 10 (23) Based on worsening OCD relative to posttreatment (Week 12) severity Y-BOCSZ25% above Week 12 Y-BOCS + CGI-I of much or very much worse [Maina et al, 2001 b ; Ravizza et al, 1996] 3 (27) 0 (0) 1 (7) 4 (9) Loss of Z50% Y-BOCS improvement from treatment + CGI-I of much or very much worse + Y-BOCS total score Z19 [Romano et al, 2001] 3 (27) 0 (0) 1 (7) 4 (9) Y-BOCSZ5 and CGI-IZ1 above Week 12 scores + Y-BOCS total score Z20 [Koran et al, 2002 b ] 3 (27) 1 (6) 1 (7) 5 (11) Y-BOCS total score Z16 if Week 12 Y-BOCS o16 c [Eisen et al, 1999] [Leonard et al, 1989] 5 (45) 8 (44) 8 (53) 21 (48) Y-BOCSZ25% above Week 12 Y-BOCS or CGI-I of much or very much worse [Pallanti et al, 2002] 5 (45) 9 (50) 10 (67) 24 (55) Other Return to Week 0 Y-BOCS or CGI-SZ1 above Week 12 CGI-S [Hollander et al, 2003] 4 (36) 3 (17) 7 (47) 14 (32) Treatment responders (total: n ¼ 44) were followed for 12 weeks after treatment discontinuation. For each relapse definition, the number of relapsers and the relapse rates (number of relapsers/number of responders) are presented for each treatment group and for the total sample of 44 responders.…”

Response to serotonin reuptake inhibitors in OCD is not influenced by common CYP2D6 polymorphisms

“…On the other hand, a few studies report on a doseÁresponse relationship: A larger study observed higher venlafaxine blood levels in responders compared to non-responders, but found no evidence for a relationship between treatment outcome and blood levels of paroxetine [12]. Hollander et al reported that paroxetine doses of 40 and 60 mg/day (but not 20 mg/day) are effective in treating acute obsessive-compulsive disorder [13]. Yaryura-Tobias et al indicate that doses of venlafaxine less than 225 mg/day are not effective in OCD [14].…”

The Efficacy of Psychoneurotherapy on Reducing Symptoms Severity in Treatment Naïve Patients With Obsessive-Compulsive Washing

“…Currently, pharmacological treatment like Serotonin Reuptake Inhibitors (SRIs) and Cognitive Behavior Therapy (CBT) are the selected treatments for OCD. Potential side effects of the drug and relapse rates (24% to 89%) are the main problems of pharmacological treatment in patients with OCD (Hollander et al, 2003;Koran, Hackett, Rubin, Wolkow, & Robinson, 2002). Relapse rate of the disease within three months after the CBT termination was higher than 50% (Simpson, Franklin, Cheng, Foa, & Liebowitz, 2005;Anand, Sudhir, Math, Thennarasu, & Reddy, 2011).…”