Efficacy and Tolerability of Serotonin Transport Inhibitors in Obsessive-compulsive Disorder

Greist, John H.

doi:10.1001/archpsyc.1995.03950130053006

Cited by 408 publications

(174 citation statements)

References 42 publications

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“…The fact that the six medicated OCD patients had not adequately responded to pharmacotherapy and still had moderate to severe OCD symptoms at study entry suggests that they might represent a relatively medication-refractory group that might be neurobiologically different from more SRI-responsive OCD patients. 63 However, approximately 50% of all OCD patients have similarly inadequate responses to SRI medications, 20,64 indicating that it is more the rule than the exception. So our sample is likely quite representative of the range of SRI responsivity found in among OCD patients in the 'real world.'…”

Section: Discussionmentioning

confidence: 99%

“…18,19 Clinical response of OCD symptoms usually requires up to 12 weeks of treatment with SRI medications and standard, weekly outpatient CBT. 20 The response of OCD symptoms to SRI medications is thought to depend on the downregulation of terminal serotonin 1d b receptors and subsequent increase in serotonin release in the OFC, which require at least 8 weeks of SRI administration. 21 However, very little is known about the brain mediation of response to CBT in OCD.…”

Section: Introductionmentioning

confidence: 99%

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Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

124

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Brief intensive cognitive-behavioral therapy (CBT) using exposure and response prevention significantly improves obsessive-compulsive disorder (OCD) symptoms in as little as 4 weeks. However, it has been thought that much longer treatment was needed to produce the changes in brain function seen in neuroimaging studies of OCD. We sought to elucidate the brain mediation of response to brief intensive CBT for OCD and determine whether this treatment could induce functional brain changes previously seen after longer trials of pharmacotherapy or standard CBT. [ 18 F]-fluorodeoxyglucose positron emission tomography brain scans were obtained on 10 OCD patients before and after 4 weeks of intensive individual CBT. Twelve normal controls were scanned twice, several weeks apart, without treatment. Regional glucose metabolic changes were compared between groups. OCD symptoms, depression, anxiety and overall functioning improved robustly with treatment. Significant changes in normalized regional glucose metabolism were seen after brief intensive CBT (P = 0.04). Compared to controls, OCD patients showed significant bilateral decreases in normalized thalamic metabolism with intensive CBT but had a significant increase in right dorsal anterior cingulate cortex activity that correlated strongly with the degree of improvement in OCD symptoms (P = 0.02). The rapid response of OCD to intensive CBT is mediated by a distinct pattern of changes in regional brain function. Reduction of thalamic activity may be a final common pathway for improvement in OCD, but response to intensive CBT may require activation of dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

124

View full text Add to dashboard Cite

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“…This has been derived mostly by data from pharmacological studies showing that SSRIs are successfully used for the treatment of both OCD (Greist et al 1995;Mundo et al 1997) and bipolar depression (Potter 1998). However, the 5HT system is complex, and several studies have pointed out that the mechanisms of action of SSRIs in inducing the antidepressant and the antiobsessional clinical responses are substantially different and involve different 5HT receptors (Blier and de Montigny 1998).…”

Section: Discussionmentioning

confidence: 99%

The 5HT1Dβ Receptor Gene in Bipolar Disorder A Family-based Association Study

Mundo

Zai

Lee

et al. 2001

Neuropsychopharmacology

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“…Clomipramine efficacy could also be demonstrated in DBPC studies in children and adolescents with OCD (DeVeaugh-Geiss et al 1992;Flament et al 1985)(A). The available evidence based on eight head-tohead comparisons suggests that there are no differences in efficacy between clomipramine and SSRIs (Zohar and Kindler 1992), and contradicts other (not head-to-head) studies which propose that clomipramine has greater anti-obsessional efficacy than do the SSRIs (Abramowitz 1997; Bisserbe et al 1997;Greist et al 1995c;Piccinelli et al 1995;Pigott and Seay 1999;Todorov et al 2000). Some direct comparisons suggest that SSRIs are better tolerated than clomipramine while having the same efficacy (Bisserbe et al 1997;Milanfranchi et al 1997;Mundo et al 2000;Zohar and Judge 1996;Zohar 2008).…”

Section: Tricyclic Antidepressants (Tcas) Efficacy Has Beenmentioning

confidence: 97%

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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Efficacy and Tolerability of Serotonin Transport Inhibitors in Obsessive-compulsive Disorder

Abstract: While the results of this meta-analysis support the superiority of clomipramine, head-to-head, double-blind comparisons of these compounds would be the best test of comparative efficacy and tolerability.

Cited by 408 publications

References 42 publications

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

The 5HT1Dβ Receptor Gene in Bipolar Disorder A Family-based Association Study

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

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