Fluvoxamine in obsessive‐compulsive disorder: similar efficacy but superior tolerability in comparison with clomipramine

Mundo, Emanuela; Rouillon, Frédéric; Figuera, Maria Luisa; Stigler, Michael

doi:10.1002/hup.317.abs

Cited by 7 publications

(10 citation statements)

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“…In support of the latter explanation, there are now 6 head-to-head, double-blind comparisons of various SSRIs and CMI, using sample sizes of at least 30 patients per Not indicated for OCD, but a double-blind paroxetine-controlled study showed equal effectiveness treatment arm, showing essentially no difference between the tricyclic and the SSRIs (30)(31)(32)(33)(34)(35). As expected, however, tolerability was better for the SSRIs in most trials.…”

Section: Direct Comparisons Of Ssris and The Sri CMImentioning

confidence: 78%

Pharmacotherapies in the Management of Obsessive—Compulsive Disorder

2006

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T he first reports of the potential for medications to exert an antiobsessional effect in patients without major depression were published about 35 years ago (1-4). The tricyclic antidepressant G-34586, or CMI, was used successfully in these first attempts. The serendipitous finding of its beneficial effect on obsessions in depression patients motivated its use in that disorder. Several case series in the following decade seemed to confirm the usefulness of this medication in treating OCD, then denoted obsessive-compulsive neurosis. The first controlled trials demonstrating a therapeutic action of CMI in OCD were published in 1980 (5,6). These were followed by many positive studies (see 7 for a review). Clinical Implications· OCD is a chronic disorder amenable to pharmacotherapy using a single class of medications: the potent SRIs. · With a good knowledge of the properties of these drugs, optimal response and patient safety and comfort can be achieved. · It is possible to augment the anti-OCD response with various augmentation strategies. · The response to various pharmacotherapies is generally partial, and their administration must be prolonged to avoid the resurgence of symptoms. Limitations· SRIs exert class side effects that are sometimes difficult to minimize. · Few augmentation strategies are supported by double-blind studies.Few medications are effective in treating obsessive-compulsive disorder (OCD). As monotherapy, only potent serotonin (5-HT) reuptake inhibitors (SRIs) consistently exert an intrinsic therapeutic action in OCD. Their use in OCD, however, differs from their use in depression. This paper first reviews the evidence supporting the key role of 5-HT as a pivotal neurotransmitter in the anti-OCD response. Then, we describe the practicalities of SRI use, followed by the steps that can be taken when these medications do not produce an adequate clinical response. We provide specifics for the treatment of children and adolescents with OCD. We include a brief description of the brain circuitry involved in OCD and the mechanisms of action of the pharmacologic agents reported to be effective in this disorder, as well as those that are useful in depression but not in OCD. We present this information to promote better understanding of the research endeavours needed to develop new pharmacotherapeutic approaches. Information on funding and support and author affiliations appears at the end of the article.

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Section: Direct Comparisons Of Ssris and The Sri CMImentioning

confidence: 78%

Pharmacotherapies in the Management of Obsessive—Compulsive Disorder

2006

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“…76 Fluvoxamine demonstrated similar efficacy but superior tolerability over clomipramine in a group of 227 patients. 77 A multicenter study also reported comparable effectiveness of fluvoxamine and clomipramine but better tolerability with the former. 78 Fluvoxamine has demonstrated effectiveness in children and adolescents with OCD.…”

Section: Pharmacotherapymentioning

confidence: 93%

“…65 Headto-head studies of SSRIs and clomipramine have found similar efficacy. 77,84 Clomipramine has many disadvantages over SSRIs. Clomipramine has the potential for cardiac toxicity including QTc prolongation.…”

Section: Clomipraminementioning

confidence: 99%

Obsessive–Compulsive Disorder

Bokor

Anderson²

2014

Journal of Pharmacy Practice

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Obsessive-compulsive disorder (OCD) is a common heterogeneous psychiatric disorder manifesting with obsessions and compulsions. Obsessions are intrusive, recurrent, and persistent unwanted thoughts. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to the obsessions. The heterogeneity of OCD includes themes of obsessions, types of rituals, presence or absence of tics, etiology, genetics, and response to pharmacotherapy. Complications of OCD include interpersonal difficulties, unemployment, substance abuse, criminal justice issues, and physical injuries. Areas of the brain involved in the pathophysiology include the orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia. Overall, OCD may be due to a malfunction in the cortico-striato-thalamo-cortical circuit in the brain. Neurotransmitters implicated in OCD include serotonin, dopamine, and glutamate. Numerous drugs such as atypical antipsychotics and dopaminergic agents can cause or exacerbate OCD symptoms. The etiology includes genetics and neurological insults. Treatment of OCD includes psychotherapy, pharmacotherapy, electroconvulsive therapy, transcranial magnetic simulation, and in extreme cases surgery. Exposure and response prevention is the most effective form of psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy. Higher doses than listed in the package insert and a longer trial are often needed for SSRIs than compared to other psychiatric disorders. Alternatives to SSRIs include clomipramine and serotonin/norepinephrine reuptake inhibitors. Treatment of resistant cases includes augmentation with atypical antipsychotics, pindolol, buspirone, and glutamate-blocking agents.

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“…Paroxetine (200)(201)(202), fluoxetine (203)(204)(205)(206)(207)(208), citalopram (209,210), fluvoxamine (205,207,208,(211)(212)(213), sertraline (204,205,207,208,(214)(215)(216) and escitalopram (217) have all demonstrated efficacy in placebo-controlled trials. Other agents shown to demonstrate efficacy are clomipramine (205,207,208,(217)(218)(219)(220) and the MAOI phenelzine (221).…”

Section: Obsessive-compulsive Disordermentioning

confidence: 99%