The efficacy of clomipramine and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) in treating obsessive-compulsive disorder (OCD) is now established. However, few studies are available on long term treatment strategies in patients with OCD. In this article, recent literature on drug discontinuation and maintenance treatment of OCD is reviewed and discussed.
All studies which have evaluated recurrence rates after drug discontinuation have found that up to 80% of patients who respond to SSRIs relapse if the medication is withdrawn.
The studies that have been performed on long term treatment of OCD with both clomipramine and SSRIs show that patients who continue medication maintain and slightly increase the level of improvement achieved in short term trials. Several authors suggest that, in maintenance treatment, drug dosages can be reduced to between 40 and 60% of those used in acute episodes without a significant difference in symptom improvement.
Preliminary data concerning drug tolerability in patients receiving long term treatment for OCD indicate that SSRIs are well tolerated, and that the rate of adverse effects tends to decrease compared with short term treatment. Several recent reports suggest that patients who have taken SSRIs for at least 2 months are at risk of developing withdrawal symptoms when treatment is discontinued. However, no data are available concerning the relationship between the duration of OCD treatment and the onset of withdrawal symptoms.
Adis International Limited Fluoxetine Paroxetine Sertraline Fluvoxamine
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Cottreaux J, Mollard E, Bouvard M, et al. Acontrolled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacol 1990; 5: 17–30CrossRefGoogle Scholar
Montgomery SA, McIntyre A, Osterheider M, et al. A double-blind, placebo-controlled study of fluoxetine in patients with DSM-III-R obsessive-compulsive disorder. Eur Neuropsychopharmacol 1993; 3: 143–52PubMedCrossRefGoogle Scholar
Tollefson GD, Rampey AH, Potvin JH, et al. A multicenter investigation of fixed-dose fluoxetine in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 1994; 51: 559–67PubMedCrossRefGoogle Scholar
Greist JH, Jefferson JW, Kobak KA, et al. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder: a meta-analysis. Arch Gen Psychiatry 1995; 52: 53–60PubMedCrossRefGoogle Scholar
Greist JH, Chouinard G, DuBoff E, et al. Double-blind, parallel comparison of three doses of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psychiatry 1995; 52: 289–95PubMedCrossRefGoogle Scholar
Piccinelli M, Pini S, Bellantuono C, et al. Efficacy of drug treatment in obsessive-compulsive disorder: a meta-analytic review. Br J Psychiatry 1995; 166: 424–43PubMedCrossRefGoogle Scholar
Zohar J, Rajinder J, OCD Paroxetine Study Investigators. Paroxetine versus clomipramine in the treatment of obsessive-compulsive disorder. Br J Psychiatry 1996; 169: 468–74PubMedCrossRefGoogle Scholar
Capstick N. The Grayling well study. J Int Med Res 1973; 1: 392–6Google Scholar
Thorén P, Asberg M, Cronholm B. Clomipramine treatment of obsessive-compulsive disorder: I. A controlled clinical trial. Arch Gen Psychiatry 1980; 37: 1281–5PubMedCrossRefGoogle Scholar
Fontaine R, Chouinard G. Fluoxetine in the long-term treatment of obsessive compulsive disorder. Psychiatr Ann 1989; 19: 88–91Google Scholar
Yaryura-Tobias JA, Neziroglu F, Bergmann L. Chlorimipramine for obsessive-compulsive neurosis: an organic approach. Curr Ther Res 1976; 20: 541–7Google Scholar
Flament MF, Rapoport JL, Berg CJ. Clomipramine treatment of childhood obsessive-compulsive disorder: a double blind controlled study. Arch Gen Psychiatry 1985; 42: 977–83PubMedCrossRefGoogle Scholar
Pato MT, Zohar-Kadouch R, Zohar J. Return of symptoms after discontinuation of clomipramine in patients with obsessive-compulsive disorder. Am J Psychiatry 1988; 145: 1521–5PubMedGoogle Scholar
Pato M, Murphy DL, De Vane CL. Sustained plasma concentrations of fluoxetine and/or norfluoxetine four and eight weeks after fluoxetine discontinuation. J Clin Psychopharmacol 1991; 11: 245–51CrossRefGoogle Scholar
Leonard HL, Swedo SE, Lenane MC, et al. A double-blind substitution during long-term clomipramine treatment in children and adolescents. Arch Gen Psychiatry 1991; 48: 922–7PubMedCrossRefGoogle Scholar
Orloff LM, Battle MA, Baer L, et al. Long-term follow-up of 85 patients with obsessive-compulsive disorder. Am J Psychiatry 1994; 151: 441–2PubMedGoogle Scholar
Ravizza L, Barzega G, Bellino S, et al. Drug treatment of obsessive-compulsive disorder: long term trial with clomipramine and SSRI. Psychopharmacol Bull 1996; 32: 167–73PubMedGoogle Scholar
March JS, Frances A, Carpenter D, et al. The Expert Consensus Guidelines Series: treatment of obsessive-compulsive disorder. J Clin Psychiatry 1997; 58Suppl. 4: 1–64Google Scholar
Maina G, Albert U, Barzega G, et al. Drug discontinuation in obsessive-compulsive patients [abstract]. Biol Psychiatry 1997; 42Suppl. 1: 139SCrossRefGoogle Scholar
Tollefson GD, Birkett M, Koran L, et al. Continuation treatment of OCD: double-blind and open-label experience with fluoxetine. J Clin Psychiatry 1994; 55(10 Suppl.): 69–76PubMedGoogle Scholar
Greist JH, Jefferson JW, Kobakk KA, et al. A one-year double-blind placebo controlled fixed dosage study of sertraline in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol 1995; 10: 57–66PubMedCrossRefGoogle Scholar
Pato MT, Hill JL, Murphy PL. A clomipramine dosage reduction study in the course of long-term treatment of obsessive-compulsive disorder patients. Psychopharmacol Bull 1990; 26: 211–4PubMedGoogle Scholar
Mundo E, Bareggi SR, Pirola R, et al. Long-term pharmacotherapy of obsessive-compulsive disorder: a double-blind controlled study. J Clin Psychopharmacol 1997; 17: 4–10PubMedCrossRefGoogle Scholar
Greist JH. New developments in behaviour therapy for obsessive-compulsive disorder. Int Clin Psychopharmacol 1996; 11Suppl. 5: 63–74PubMedCrossRefGoogle Scholar
Hollander E. Quality of life and pharmacoeconomic issues in OCD and spectrum disorders [abstract no. 22A]. In: OCD: New Perspectives and Practical Management, satellite symposium to Annual American Psychiatric Association meeting; 1996 May 6–8: New York. Washington, DC: American Psychiatric Association, 1996: 306Google Scholar