title: Sertraline and Fluoxetine Treatment of Obsessive-Compulsive Disorder: Results of a Double-Blind, 6-Month Treatment Study Quetiapine augmentation of SRIs in treatment refractory obsessive-compulsive disorder: a double-blind, randomised, placebo-controlled study [ISRCTN83050762] Risperidone augmentation in the treatment of severe adolescent OCD in SSRI-refractory cases: a case-series. Escitalopram prevents relapse of obsessive-compulsive disorder Amisulpiride augmentation in treatment resistant obsessive-compulsive disorder: an open trial. Serotonin Transporter Imaging with [123I]β-CIT SPECT before and after One Year of Citalopram Treatment of Obsessive-Compulsive Disorder A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Double-blind comparison of fluoxetine versus clomipramine in the treatment of obsessive compulsive disorder A double-blind comparison of sertraline and clomipramine in outpatients with obsessive-compulsive disorder. A double-blind, placebo-controlled study of the efficacy and safety of controlled-release fluvoxamine in patients with obsessive-compulsive disorder. Low-dose risperidone augmentation of fluvoxamine treatment in obsessive-compulsive disorder: a double-blind, placebo-controlled study Efficacy of sertraline in the long-term treatment of obsessive-compulsive disorder. Fluvoxamine versus clomipramine for obsessive-compulsive disorder: a double-blind comparison. Adding quetiapine to SRI in treatment-resistant obsessive–compulsive disorder: a randomized controlled treatment study A double-blind combination study of clonazepam with sertraline in obsessive-compulsive disorder. Quetiapine augmentation in patients with treatment resistant obsessive–compulsive disorder: a single-blind, placebo-controlled study Fluvoxamine in obsessive-compulsive disorder: similar efficacy but superior tolerability in comparison with clomipramine. Olanzapine augmentation of paroxetine-refractory obsessive-compulsive disorder Augmentation strategy with olanzapine in resistant obsessive compulsive disorder: an Italian long-term open-label study
abstract: The purpose of this study was to evaluate the comparative efficacy and tolerability of sertraline and fluoxetine in the treatment of obsessivecompulsive disorder ( OCD ) . Out patients meeting DSM-IV criteria for OCD , with a Yale-Brown Obsessive-Compulsive ( Y-BOCS ) total score ≥ 17 , an NIMH Global Obsessive-Compulsive ( NIMH-OC ) scale score ≥ 7 , and a CGI-Severity score ≥ 4 were r and omized to 24 weeks of double-blind treatment with sertraline ( N = 77 ) or fluoxetine ( N = 73 ) . Primary efficacy measures consisted of the Y-BOCS , the NIMH-OC scale , and the CGI-Severity ( CGI-S ) and Improvement ( CGI-I ) scales . Equivalent and significant ( p < 0.001 ) improvement was found at week 24 in Y-BOCS and NIMH-OC scale scores  for sertraline and fluoxetine . After 12 weeks , 49.2 % of patients on sertraline were rated on the CGI-S scale as being mildly ill or not ill compared to 24.6 % on fluoxetine ( p < 0.01 ) . A Cox analysis found patients on sertraline to have a statistically nonsignificant 42 % greater likelihood of achieving a response by week 12 ( CGI-I , much or very much improved ; 95 % CI , 0.85 , 2.38;p = 0.18 ) . Sertraline treatment also result ed in a higher proportion of remissions  than fluoxetine ( defined as a CGI-I ≤ 2 and a Y-BOCS score ≤ 11 ) , both at week 12 ( 20 % vs. 8 % ; χ2 , 3.95;df 1;p = 0.047 ) and week 24 ( 36 % vs. 22 % ; χ2 , 3.18;df , 1;p = 0.075 ) . Both medications were welltolerated and demonstrated significant efficacy in the treatment of out patients with moderate to severe OCD with the subjects treated with sertraline showing a greater likelihood of remission as well as an earlier improvement on some but not all efficacy Background Although serotonin reuptake inhibitors are effective in the treatment of OCD , many patients fail to respond to these agents . Growing evidence from open-label and placebo-controlled trials suggests a role for augmentation of SRIs with atypical antipsychotics in OCD . Quetiapine is generally well tolerated and previous open-label data has produced mixed results in OCD and additional controlled data is needed . Methods We undertook a double-blind , r and omised , parallel-group , flexible-dose , placebo-controlled study of quetiapine augmentation in subjects who had responded inadequately to open-label treatment with an SRI for 12 weeks . Following informed consent and screening , forty-two subjects were r and omised to either placebo or quetiapine for six weeks . Results There was significant improvement from baseline to endpoint on the Yale-Brown Obsessive-Compulsive Scale in both the quetiapine and placebo groups ( quetiapine , n = 20 , p < 0.0001 ; placebo , n = 21 , p = 0.001 ) with 40 % ( n = 8) of quetiapine and 47.6 % ( n = 10 ) of placebo treated subjects being classified as responders . Quetiapine did not demonstrate a significant benefit over placebo at the end of the six-week treatment period ( p = .636 ) . Similarly quetiapine failed to separate from placebo in the subgroup of subjects ( n = 10 ) with co-morbid tics . Quetiapine was generally well tolerated . Conclusions In this study , quetiapine augmentation was no more effective than placebo augmentation of SRIs . A number of limitations in study design make comparisons with previous studies in this area difficult and probably contributed to our negative findings . Future work in this important clinical area should address these limitations BACKGROUND AND METHODS The adverse effects and potential clinical value of risperidone as augmentation to selective serotonin reuptake inhibitor ( SSRI ) treatment in treatment resistant severe adolescent OCD patients were examined in 17 adolescents ( 15 - 19 years old , 8 males and 9 females ) in an open label trial of risperidone  1 - 2 mg daily . RESULTS After 12 weeks of augmenting treatment , statistically significant improvements were reflected in OCD symptom ratings ( mean total Y-BOCS/CY-BOCS scores after treatment with second SSRI 24.2 + /- 2.6 versus 19.9 + /- 2.9 , p < 0.001 ) and global assessment scores ( mean CGAS , 69.4 + /- 11.4 versus 74.7 + /- 9.6 , p < 0.001 ) . Four patients had moderate improvement of more than 25 % reduction in Y-BOCS scores in OCD symptoms . Further 10 patients had a reduction of 10 - 25 % in total score , indicating slight improvement . One patient ( 6 % ) dropped from clinical OCD to a sub clinical level of OCD ( Y-BOCS total score < 15 ) . No patient was found to have worsened during augmentation treatment . Eight cases had weight gain and sedation was reported in four cases . CONCLUSION These preliminary findings suggest that augmentation with risperidone in dosages up to 2 mg daily might be efficient in adolescents with treatment resistant OCD To examine the efficacy and tolerability of escitalopram in the prevention of relapse in patients with OCD , 468 patients with OCD were treated with open label escitalopram ( 10 mg or 20 mg ) for 16 weeks , after which the 320 responders ( Y-BOCS total score decrease > or = 25 % ) were r and omised to placebo or escitalopram ( at the assigned dose ) for 24 weeks double-blind treatment . The primary analysis ( time to relapse ) showed a significant advantage for escitalopram ( p<0.001 , log-rank test ) . The proportion of patients who relapsed was statistically significantly higher in the placebo group ( 52 % ) than in the escitalopram group ( 23 % ) ( p<0.001 , chi(2)-test ) . The risk of relapse was 2.74 times higher for placebo compared to escitalopram . Escitalopram was well tolerated and improvements in obsessive-compulsive symptoms reported during the open label period were sustained during the double-blind extension of treatment with active drug . These results demonstrate that escitalopram is effective for long-term treatment and relapse prevention in OCD Despite the effectiveness of clomipramine and selective serotonin reuptake inhibitors ( SSRIs ) in the treatment of obsessive-compulsive disorder ( OCD ) , 40 % to 60 % of patients who receive an adequate treatment with these agents have significant persisting symptoms . Newer atypical antipsychotic drugs showed efficacy as augmenting agents in patients with OCD resistant to serotonin reuptake inhibitors ( SRIs ) . The objective of this study was to evaluate the efficacy and safety of amisulpiride augmentation in treatment resistant OCD . A total of 20 patients diagnosed with OCD according to DSM-IV criteria and having a history of resistance to treatment with SRIs were included in the study .  Amisulpiride 200 mg/day was added to ongoing SRI treatment and titrated up to 600 mg/day in flexible doses . The mean amisulpiride dose was 325 + /- 106 mg/day . The patients were assessed with the Yale-Brown obsessive-compulsive scale ( Y-BOCS ) at baseline and at week 12 of amisulpiride treatment . Side effects were monitored by the UKU side effect rating scale . The reduction in Y-BOCS scores between the baseline ( 26.7 + /- 6.3 ) and the end of the treatment ( 12.5 + /- 2.8 ) was statistically significant ( p=0.0001 ) . The most commonly observed side effects included weight gain ( 14 patients , 70 % ) , mild sedation ( 13 patients , 65 % ) and asthenia ( 7 patients , 35 % ) . This study has several limitations and , hence , the results are preliminary and require confirmation in a r and omized controlled trial . In conclusion , this study suggests that amisulpiride may be a promising option as an augmentation strategy in treatment resistant OCD Background : Two thirds of patients with obsessive-compulsive disorder ( OCD ) respond to treatment with selective serotonin reuptake inhibitors ( SSRIs ) . The neurobiological mechanisms of SSRI action and failure to respond to SSRI treatment remain to be eluci date d. Objectives : The aim of this pilot study was to quantify changes in the availability of serotonin transporter ( SERT ) in the course of SSRI treatment and to relate these changes to improvements of clinical symptoms . Methods : Ten patients with OCD were investigated at baseline and 5 of them after 1 year of SSRI treatment with citalopram 60 mg per day using brain single photon emission computed tomography and [123I]β-CIT .  Specific-to-nondisplaceable [123I]β-CIT binding ratios ( V3″ ) were calculated in SERT-rich brainstem , midbrain and thalamus using a magnetic resonance imaging-based region of interest ( ROI ) analysis . Symptom severity was evaluated with the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) . Results : V3″ differed significantly between pretreatment and follow-up scans in all three brain regions , thalamus , midbrain as well as in brainstem . In thalamic ROI , differ ences in SERT availability and Y-BOCS ratings correlated . In midbrain , a trend toward a significant association was found . In brainstem , no relationship was revealed . Conclusions : Higher occupancy of SERT by citalopram seems to be associated with better clinical response after 1 year of SSRI treatment of patients with OCD BACKGROUND To date , only 1 controlled study has found a drug ( haloperidol ) to be efficacious in augmenting response in patients with obsessive-compulsive disorder ( OCD ) refractory to serotonin reuptake inhibitor ( SRI ) monotherapy ; patients with comorbid chronic tic disorders showed a preferential response . This report describes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone . METHODS Seventy adult patients with a primary DSM-IV diagnosis of OCD received 12 weeks of treatment with an  SRI . Thirty-six patients were refractory to the SRI  and were r and omized in a double-blind manner to 6 weeks of risperidone ( n = 20 ) or placebo ( n = 16 ) addition . Behavioral ratings , including the Yale-Brown Obsessive Compulsive Scale , were obtained at baseline and throughout the trial . Placebo-treated patients subsequently received an identical open-label trial of risperidone addition . RESULTS For study completers , 9 ( 50 % ) of 18 risperidone-treated patients were responders ( mean daily dose , 2.2 + /-0.7 mg/d ) compared with 0 of 15 in the placebo addition group ( P<. 005 ) . Seven ( 50 % ) of 14 patients who received open-label risperidone addition responded . Risperidone addition was superior to placebo in reducing OCD ( P<.001 ) , depressive ( P<.001 ) , and anxiety ( P = .003 ) symptoms . There was no difference in response between OCD patients with and without comorbid diagnoses of chronic tic disorder or schizotypal personalty disorder . Other than mild , transient sedation , risperidone was well tolerated . CONCLUSION These results suggest that OCD patients with and without comorbid chronic tic disorders or schizotypal personality disorder may respond to the addition of low-dose risperidone to ongoing SRI therapy There is evidence of the clinical efficacy and safety of clomipramine and the newer selective serotonin reuptake inhibitors ( SSRIs ) for the treatment of obsessive-compulsive disorder ( OCD ) . In the present study , we have compared the efficacy and safety of 40 mg/day of fluoxetine and 150 mg/day of clomipramine in patients with OCD , diagnosed according to DSM-IIIR . A total of 55 patients entered this 8-week , double-blind controlled study . Efficacy for both drugs was comparable . The primary efficacy criterion , the Y-BOCS Total score , did not show any significant differences between treatment arms . Response rate was higher with clomipramine , using a 25 % decrease in Y-BOCS Total score as response threshold , but there were no significant differences between treatment arms using a 35 % threshold . Overall safety and tolerability were good for both drugs , being slightly better for fluoxetine The aim of this study was to compare the efficacy , safety , and tolerability of sertraline and clomipramine in the treatment of obsessive-compulsive disorder ( OCD ) . Out patients with DSM-III-R defined OCD for 1 year or longer and scores of > /=20 on the YaleBrown Obsessive Compulsive Scale ( Y-BOCS ) , > /=7 on the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH-OC ) , > /=4 on the Clinical Global Impression Severity of Illness Scale ( CGI-S ) and < /=17 on the Hamilton Depression Scale ( 17 item HAMD ) were r and omized to sertraline  ( n = 86 ) or  clomipramine  ( n = 82 ) once daily for 16 weeks . Initial daily doses of sertraline and clomipramine were 50 mg . After a minimum of 4 weeks , these doses could be increased by 50 mg increments every 2 weeks to a maximum of 200 mg daily if the response was thought inadequate . Efficacy was assessed at the end of 1 , 2 , 4 , 6 , 8 , 12 and 16 weeks of therapy using the Y-BOCS , NIMH-OC , CGI-S , CGI Improvement Scale ( CGI-I ) and Clinical Anxiety Scale ( CAS ) .  One hundred sixty-eight patients were r and omized and received at least one dose of double-blind medication ; 86 received sertraline and 82 clomipramine . Mean final daily doses at final visit were clomipramine 90 mg ( efficacy evaluable patients 101 mg , completers 110 mg ) , and sertraline 129 mg ( efficacy evaluable patients 132 mg , completers 136 mg ) . Mean baseline Y-BOCS , NIMH-OC and CGI-S totals were 27.7 , 10.1 and 5.5 , respectively , for sertraline and 27.4 , 9.9 and 5.5 , respectively , for clomipramine . Sertraline demonstrated greater efficacy than clomipramine in the intent-to-treat patient group : mean baseline to final visit changes were 50.8 % ( Y-BOCS ) , 41.9 % ( NIMH-OC ) and 37.7 % ( CGI-S ) for sertraline and 42.9 % ( Y-BOCS ) , 33.8 % ( NIMH-OC ) and 30.0 % ( CGI-S ) for clomipramine ( P < 0.05 ) . The number of patients withdrawing because of adverse events was substantially greater for clomipramine ( 26 % ) than sertraline ( 11 % ) ( P < 0.05 ) . The most frequent adverse events for clomipramine were dry mouth ( 20 % ) , anxiety ( 17 % ) , constipation ( 16 % ) , nausea ( 15 % ) and somnolence ( 11 % ) , and for sertraline , diarrhea ( 12 % ) and nausea ( 12 % ) . In this study , sertraline was more effective than clomipramine in the intent-to-treat analysis . The difference in efficacy between the treatments is almost wholly accounted for by a greater number of clomipramine withdrawals due to the poor patient acceptance of clomipramine . The superior tolerability of sertraline and the lower rate of premature treatment withdrawal relative to clomipramine may offer considerable quality of life and compliance benefits in the long-term management of a chronic disorder such as OCD OBJECTIVE The aim of this 12-week , double-blind , flexible-dose , placebo-controlled , parallel-arm , multicenter trial was to determine the safety and efficacy of fluvoxamine in a controlled-release ( CR ) formulation in adult out patients with obsessive-compulsive disorder ( OCD ) . METHOD 253 adult out patients with DSM-IV OCD were r and omly assigned to receive 100 to 300 mg of fluvoxamine CR ( N = 127 ) or placebo ( N = 126 ) once daily for 12 weeks . Intent-to-treat analyses of efficacy assessment s with the Yale-Brown Obsessive Compulsive Scale ( YBOCS ) , Clinical Global Impressions-Severity of Illness scale ( CGI-S ) , and Clinical Global Impressions-Improvement scale ( CGI-I ) were conducted . RESULTS Fluvoxamine CR was significantly ( p < .05 ) superior to placebo in decreasing YBOCS total score beginning at week 2 . This early response was sustained at all subsequent visits . At endpoint , there was a mean decrease of 8.5 + /- 0.7 ( 31.7 % ) in the YBOCS total score compared with baseline in the fluvoxamine CR treatment group versus a mean decrease of 5.6 + /- 0.7 ( 21.2 % ) in the placebo group ( p = .001 ) . Fluvoxamine CR was also significantly superior to placebo in lowering the severity of illness ( CGI-S , p = .002 ) and in producing clinical improvement ( CGI-I , p < .01 ) . At endpoint , significantly greater percentages of the fluvoxamine CR treatment group were responders ( p = .002 ) and remitters ( p = .019 ) compared with the placebo group . CONCLUSION Over 12 weeks , fluvoxamine CR treatment was associated with a statistically significant and clinical ly relevant reduction in OCD severity and was found to be safe and well tolerated . The early onset of therapeutic effect , starting from week 2 , was of particular interest According to previous data , the addition of risperidone in obsessive-compulsive patients refractory to serotonin reuptake inhibitors ( SRIs ) is shown to be a safe and effective treatment strategy . The aims of our study were to evaluate the efficacy of risperidone addition , in comparison to placebo , in fluvoxamine-refractory obsessive-compulsive patients and to investigate whether risperidone could boost the efficacy of fluvoxamine in fluvoxamine-responder patients . Subjects were 45 obsessive-compulsive in patients , consecutively recruited at the Department of Neurosciences at the San Raffaele Hospital , Milan . Thirty-nine patients completed the study . All patients received 12 weeks of a st and ardized open-label fluvoxamine monotherapy and then continued for 6 weeks with placebo or risperidone in a double-blind design . Results showed a significant effect of risperidone addition , at the end of the double-blind phase ( 18th week ) , only for fluvoxamine-refractory patients . Five patients on risperidone ( 50 % ) and two ( 20 % ) on placebo became responders , with a Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) decrease > or = 35 % . Risperidone was generally well tolerated , except for a mild transient sedation and a mild increase in appetite . This preliminary study suggests that even very low ( 0.5 mg ) risperidone doses are effective in OC patients who were nonresponders to a st and ardized treatment with fluvoxamine OBJECTIVE Obsessive-compulsive disorder ( OCD ) typically begins early in life and has a chronic course . Despite the need for long-term treatment , the authors found no placebo-controlled studies that have examined the relapse-prevention efficacy of maintenance therapy . METHOD Patients who met criteria for response after 16 and 52 weeks of a single-blind trial of sertraline  were r and omly assigned to a 28-week double-blind trial of 50 - 200 mg/day of sertraline or placebo . Primary outcomes after the double-blind trial were full relapse , dropout due to relapse or insufficient response , or acute exacerbation of OCD symptoms . RESULTS Of 649 patients at baseline , 232 completed 52 weeks of the single-blind trial and met response criteria . Among the 223 patients in the double-blind phase of the study , sertraline had significantly greater efficacy than placebo on two of three primary outcomes : dropout due to relapse or insufficient clinical response ( 9 % versus 24 % , respectively ) and acute exacerbation of symptoms ( 12 % versus 35 % ) . Sertraline result ed in improvement in quality of life during the initial 52-week trial and continued improvement , significantly superior to placebo , during the subsequent 28-week double-blind trial . Long-term treatment with sertraline was well tolerated . Over the entire study period , less than 20 % of the patients stopped treatment because of adverse events . CONCLUSIONS Sertraline demonstrated sustained efficacy among patients responding to treatment and was generally well tolerated during the 80-week study . During the study 's last 28 weeks , sertraline demonstrated greater efficacy than placebo in preventing dropout due to relapse or insufficient clinical response and acute exacerbation of OCD symptoms The efficacy and tolerability of fluvoxamine ( 100 - 300 mg/day ) and clomipramine ( 100 - 250 mg/day ) were compared in a r and omized , double-blind , parallel-group study of 79 patients with obsessive-compulsive disorder ( OCD ) without coexisting major depression . After a 2-week placebo lead-in period , patients were r and omized to fluvoxamine ( 37 patients ) or clomipramine ( 42 patients ) for 10 weeks . Efficacy was evaluated with the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) , the National Institute of Mental Health Obsessive-Compulsive scale , and Patient and Clinical Global Improvement scales . Hamilton Rating Scale for Depression scores and somatic symptoms were also assessed . Seventy-eight percent of fluvoxamine patients and 64 % of clomipramine patients completed the study . At the end of treatment , 56 % of fluvoxamine patients were classified as responders ( > or = 25 % decrease in Y-BOCS score ) , compared with 54 % of clomipramine patients . Both groups showed steady improvement throughout the study ; no statistically significant differences were observed between the groups for any efficacy variable at any time . A similar percentage of patients in both groups withdrew because of adverse events . No serious adverse events related to drug occurred with either drug . Insomnia , nervousness , and dyspepsia were more statistically frequent with fluvoxamine ; dry mouth and postural hypotension were more frequent with clomipramine . In this study , fluvoxamine and clomipramine were equally effective in reducing OCD symptoms over a 10-week treatment period but displayed different side effect profiles This study aim ed to determine the efficacy and tolerability of adding quetiapine to a serotonin reuptake inhibitor in treatment-resistant obsessive – compulsive disorder ( OCD ) . Twenty-one adult treatment-resistant OCD patients were r and omized to 16 weeks of augmentation with either quetiapine ( n=11 ) or placebo ( n=10 ) . Patients with significant comorbidities , including tic-spectrum disorders , were not included . The treatment was well tolerated , with only one premature dropout in each treatment-group . The primary analysis showed that individuals in the quetiapine-treated group showed a 14 % mean improvement in baseline Yale – Brown Obsessive – Compulsive Scale scores at study endpoint compared with a 6 % improvement in those treated with placebo , but this difference did not reach statistical significance ( F<1 ) . Three patients treated with quetiapine met criteria for clinical response , compared to one patient who was treated with placebo . Larger studies are needed to explore the efficacy of second generation antipsychotics , such as quetiapine , when used as adjunct treatment in resistant OCD This double blind , r and omized , parallel , placebo-controlled study investigates whether clonazepam accelerates and / or increases the overall response in patients with obsessive compulsive disorder ( OCD ) who are treated with sertraline . Thirty-seven patients were r and omized with 20 in the sertraline and clonazepam group and 17 in the sertraline and placebo groups . Male and female out patients , age 18 - 65 years , met criteria for a primary diagnosis of obsessive compulsive disorder according to DSM-IV , as determined by the structured clinical MINI interview . Appropriate safety and efficacy parameters were measured throughout the study . The determination of efficacy was based primarily on changes from baseline to the last observation taken through week 12 . Analysis revealed no significant difference between groups at endpoint on the main scale Recently , atypical antipsychotics have been used for the management of the patients with refractory obsessive – compulsive disorder ( OCD ) . The aim of the present study was to evaluate the results of quetiapine augmentation to a serotonin reuptake inhibitor ( SRI ) in the patients with refractory OCD . Fifty-two patients with OCD according to DSM-IV entered 3 months of an open-label phase treatment with a SRI with or without concomitant adjunctive treatment regimen . Of them , 27 patients were refractory OCD . These patients were r and omly divided into two groups , SRI plus quetiapine and SRI plus placebo , for an 8-week single-blind phase . The course of OCD was evaluated by Yale – Brown Obsession – Compulsion ( Y-BOCS ) and Clinical Global Impression – Severity of Illness and Improvement ( CGI-SI and I ) Scales every other week for 8 weeks . Of the 14 patients in group I , nine ( 64.4 % ) showed significant improvement with 60 % or greater improvement on the Y-BOCS and one ( 7.1 % ) partial improvement with 30 % or greater improvement on the Y-BOCS , whereas no improvement was observed in group II . The addition of quetiapine to ongoing SRI therapy has been found to be effective and well-tolerated approach in patients with refractory OCD Some meta-analyses have suggested that the selective serotonin reuptake inhibitors ( SSRIs ) are less effective than clomipramine in the treatment of obsessive-compulsive disorder ( OCD ) . The aim of this double-blind , r and omised , multicentre study was to directly compare the efficacy and safety of fluvoxamine and clomipramine in patients with OCD . A total of 227 patients were r and omised to flexible doses of fluvoxamine or clomipramine ( both 150 - 300 mg/day ) for 10 weeks . Fluvoxamine and clomipramine were both clinical ly effective and there were no statistically significant differences between the two treatment groups , at any visit , on the National Institute of Mental Health Obsessive-Compulsive global rating scale , the Yale-Brown Obsessive-Compulsive scale ( total score and obsession and compulsion subscores ) , the Clinical Global Impression severity of illness and global improvement subscales , the Clinical Anxiety Scale and the 17-item Hamilton Depression Rating Scale . However , there were differences in safety between the two treatments . Compared with fluvoxamine-treated patients , those treated with clomipramine had more anticholinergic side effects ( dry mouth , constipation and tremor ) and premature withdrawals due to adverse events ( 18 versus 9 ) . The results from this controlled study indicate that fluvoxamine is as effective as clomipramine in the treatment of OCD but has a better tolerability profile . Copyright 2001 John Wiley & Sons , The aim of the present study was to investigate the effect of adjunctive olanzapine in patients with obsessive-compulsive disorder ( OCD ) refractory to paroxetine . Twenty-one patients unresponsive to treatment with paroxetine , administered for at least 12 weeks at the dose of 60 mg/day , participated to a 12-week open-label , add-on trial with olanzapine ( 10 mg/day ) . The psychopathological state was evaluated by the Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and by Clinical Global Impression ( CGI ) . Three patients did not complete the 12-week adjunctive treatment with olanzapine . In the 18 completers , the mean Y-BOCS score decreased significantly from 27.1+/-4.0 at baseline to 20.1+/-3.9 at final evaluation ( P<.001 ) . Seven patients ( 38.9 % ) were rated as responders at final evaluation . Steady-state plasma concentrations of paroxetine  were not modified during olanzapine coadministration . The drug combination was generally well tolerated and initial sedation and weight gain were the most frequent unwanted effects . Our findings confirm the results of previous studies and indicate that the addition of olanzapine to ongoing treatment with serotonin reuptake inhibitors ( SRI ) may be beneficial in some patients unresponsive to SRI monotherapy The present study reports the results of an open-label trial on the use of the combination of olanzapine ( an atypical antipsychotic ) serotonin reuptake inhibitors ( SRIs ) in 26 resistant out patients affected by resistant obsessive-compulsive disorder ( OCD ) . All patients had been suffering from OCD , according to DSM IV criteria , for at least 2 years and had different comorbid disorders ; they had been treated with an  SRI  at adequate dosages for at least 6 months , or had tried different augmentation strategies with no or poor response . As a result , olanzapine was added and continued for 1 year . After 12 weeks of this regimen , most of the patients ( 17 ) had shown a reduction in OC symptoms , as assessed by a decrease in the Yale-Brown Obsessive Compulsive Scale total score , which continued throughout subsequent months . Only mild side-effects were recorded and no patient halted the treatment . The addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients , especially in those presenting comorbidity with bipolar disorders
target: CONCLUSIONS The effects of treatment with clomipramine and selective serotonin reuptake inhibitors ( SSRIs : fluvoxamine , sertraline , fluoxetine , citalopram , and escitalopram ) proved to be similar , except for the lower adherence rate in case of clomipramine because of its side effects .
background: PURPOSE This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder ( OCD ) , addressing two major issues : which treatment is most effective in treating the patient 's symptoms and which is beneficial for maintaining remission .