Escitalopram in obsessive–compulsive disorder: a randomized, placebo-controlled, paroxetine-referenced, fixed-dose, 24-week study

Stein, Dan J.; Andersen, Elisabeth Wreford; Tonnoir, Brigitte; Fineberg, Naomi

doi:10.1185/030079907x178838

Cited by 111 publications

(57 citation statements)

References 28 publications

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“…Á Paroxetine was significantly more effective than placebo and of comparable efficacy to clomipramine (Zohar and Judge 1996). Paroxetine was also found to be effective in the DBPC comparison with escitalopram (Stein et al 2007b). Efficacy of paroxetine was also shown in a relapse prevention study.…”

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 84%

“…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%

“…Between 30 and 60% cases in acute phase DBPC studies reached a clinically relevant level of improvement. However, according to a DBPC study, responder rates increased to 70% by 24 weeks (Stein et al 2007b). During the open-label phase of a DBPC relapse prevention trial, 78% cases achieved clinical response status by the 16 week endpoint (Fineberg et al 2007).…”

Section: Other Medicationsmentioning

confidence: 99%

“…Á In a three-arm study, escitalopram was superior to placebo, as was the reference drug paroxetine (Stein et al 2007b). In a relapse prevention study, patients with OCD were treated with open label escitalopram for 16 weeks, after which the responders were randomized to placebo or escitalopram.…”

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

See 3 more Smart Citations

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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Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 84%

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

Section: Other Medicationsmentioning

confidence: 99%

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…These agents have shown efficacy in well-designed randomized trials of PTSD [54][55][56][57], panic disorder [58][59][60][61][62][63][64], GAD [60,[65][66][67], social phobia [68], and OCD [69][70][71]. These agents have repeatedly documented both acute and prophylactic efficacy and are currently considered first line agents [53].…”

Section: Treatment Of Anxiety Disordersmentioning

confidence: 99%

Comorbid Anxiety in Bipolar Disorder Alters Treatment and Prognosis

El‐Mallakh

Hollifield

2008

Psychiatr Q

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Mood disorders in general, and bipolar disorder in particular, are unique among the psychiatric conditions in that they are associated with extraordinarily high rates of comorbidity with a multitude of psychiatric and medical conditions. Among all the potential comorbidities, co-occurring anxiety disorders stand out due to their very high prevalence. Outcome in bipolar illness is worse in the presence of a comorbid anxiety disorder. The coexistence of an anxiety disorder presents a particularly difficult challenge in the treatment of bipolar illness since antidepressants, the mainstay of pharmacologic treatments for anxiety, may adversely alter the course of manic-depression. Identification of anxiety disorders in bipolar patients is important. The treatment plan needs to balance the potential benefit and harm of antidepressant administration.

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Differential Outcomes of Placebo Treatment Across 9 Psychiatric Disorders

Bschor,

Nagel,

Unger

et al. 2024

JAMA Psychiatry

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ImportancePlacebo is the only substance systematically evaluated across common psychiatric diagnoses, but comprehensive cross-diagnostic comparisons are lacking.ObjectiveTo compare changes in placebo groups in recent high-quality randomized clinical trials (RCTs) across a broad spectrum of psychiatric disorders in adult patients.Data SourcesMEDLINE and the Cochrane Database of Systematic Reviews were systematically searched in March 2022 for the latest systematic reviews meeting predetermined high-quality criteria for 9 major psychiatric diagnoses.Study SelectionUsing these reviews, the top 10 highest-quality (ie, lowest risk of bias, according to the Cochrane Risk of Bias tool) and most recent placebo-controlled RCTs per diagnosis (totaling 90 RCTs) were selected, adhering to predetermined inclusion and exclusion criteria.Data Extraction and SynthesisFollowing the Cochrane Handbook, 2 authors independently carried out the study search, selection, and data extraction. Cross-diagnosis comparisons were based on standardized pre-post effect sizes (mean change divided by its SD) for each placebo group. This study is reported following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.Main Outcome and MeasureThe primary outcome, pooled pre-post placebo effect sizes (dav) with 95% CIs per diagnosis, was determined using random-effects meta-analyses. A Q test assessed statistical significance of differences across diagnoses. Heterogeneity and small-study effects were evaluated as appropriate.ResultsA total of 90 RCTs with 9985 placebo-treated participants were included. Symptom severity improved with placebo in all diagnoses. Pooled pre-post placebo effect sizes differed across diagnoses (Q = 88.5; df = 8; P &lt; .001), with major depressive disorder (dav = 1.40; 95% CI, 1.24-1.56) and generalized anxiety disorder (dav = 1.23; 95% CI, 1.06-1.41) exhibiting the largest dav. Panic disorder, attention-deficit/hyperactivity disorder, posttraumatic stress disorder, social phobia, and mania showed dav between 0.68 and 0.92, followed by OCD (dav = 0.65; 95% CI, 0.51-0.78) and schizophrenia (dav = 0.59; 95% CI, 0.41-0.76).Conclusion and RelevanceThis systematic review and meta-analysis found that symptom improvement with placebo treatment was substantial in all conditions but varied across the 9 included diagnoses. These findings may help in assessing the necessity and ethical justification of placebo controls, in evaluating treatment effects in uncontrolled studies, and in guiding patients in treatment decisions. These findings likely encompass the true placebo effect, natural disease course, and nonspecific effects.

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Escitalopram in obsessive–compulsive disorder: a randomized, placebo-controlled, paroxetine-referenced, fixed-dose, 24-week study

Cited by 111 publications

References 28 publications

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

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

Comorbid Anxiety in Bipolar Disorder Alters Treatment and Prognosis

Differential Outcomes of Placebo Treatment Across 9 Psychiatric Disorders

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