LONDON, Feb. 26 -- Five antidepressants given for obsessive compulsive disorder all seem to confer twice the likelihood of modest symptom relief compared with placebo, found a systematic Cochrane review.
The five serotonin reuptake inhibitors, all approved by the FDA for OCD, were citalopram (Celexa), fluoxetine (Prozac) fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).
Patients taking any of the drugs had a reduction in symptoms of 25% or more, with no difference found for individual drugs, Ghulam Mustafa Soomro, Ph.D., of St. George's Hospital ľֱ School here, and colleagues reported in the Cochrane Library.
Action Points
- Explain to interested patients that antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), were modestly effective for controlling the symptoms of obsessive compulsive disorder, according to a study review.
- Explain that the authors of this review suggested that for OCD patients unwilling to deal with the side effects of these selective serotonin reuptake inhibitors, non-drug therapies such as cognitive behavioral therapy may be helpful.
The findings came from a review of 17 randomized controlled trials including 3,097 patients. The drugs were examined as an overall group and as individual drugs.
On the basis of all 17 studies, SSRIs as a group were more effective than placebo in reducing OCD symptoms six to 13 weeks after starting treatment. The weighted mean difference was -3.21 (95% CI -3.84 to -2.57) in favor of the SSRIs.
The weighted mean differences for four individual SSRIs were greater than -3.00. The weighted mean difference for sertraline was -2.45 (95% CI -3.54 to -1.35) and with CIs were slightly wider for fluoxetine studies. Altogether, the researchers said, all five SSRIs were effective for OCD symptoms versus placebo.
On the basis of 13 studies of 2,697 treatment responders, patients receiving SSRIs were nearly twice as likely as those receiving a placebo to achieve a clinical response, defined at a 25% or greater reduction in symptoms (RR 1.84, 95% CI 1.56 to 2.17).
The pooled RRs were shown to be similar for individual SSRI drugs, the researchers reported.
SSRI drugs differed in their adverse effects, although the most common adverse effect was nausea. Others included weakness, headache, insomnia, constipation, anxiety, fatigue, sedation, as well as sexual dysfunction.
Although adverse-effect data were limited, with few exceptions, the overall and individual adverse effects for the different SSRIs were always worse than for placebo and, in the majority of cases, the difference was statistically significant, the researchers said.
Although SSRIs are potentially effective for OCD patients, treatment decisions need to take into account the potential adverse effect of these drugs, Dr. Soomro said. In some patients, alternative treatments such as cognitive behavioral therapy may need to be considered.
The researchers said that on the basis of these data, in a group of patients where 10% might be expected to recover without treatment, 12 patients would have to be treated to achieve improvement for one additional patient, whereas in a group where 20% might be expected to recover without treatment, six patients would have to be treated for one to improve.
Most of the studies in this area were poorly reported and lacked sufficient data for the purpose of secondary analysis and summary, Dr. Soomro wrote. Longer trials and longer outcomes are needed to establish the necessary length of treatment. Trials involving a diverse range of ethnic and cultural groups would also ensure greater generalizability of the findings, they said.
| No financial conflicts were reported. Sources of support included the Systematic Reviews Training Unit, Institute of Child Health, London, England, and St. Georges Hospital ľֱ School in London. |
Primary Source
The Cochrane Library
Soomro GM, et al Cochrane Database of Systematic Reviews 2008; Issue 1: DOI: 10.1002/14651858.cd001765.pub 3.