The current guidelines of the World Federation of Societies
of Biological TGF-beta family Psychiatry (WFSBP) for the pharmacological treatment of OCD24 grant the highest category of evidence (“A”, ie, full evidence from several RCTs) for the SSRIs escitalopram, fluvoxamine, fluoxetine, paroxetine, and sertraline, as well as for the TCA clomipramine, but not for any other drug. Because Inhibitors,research,lifescience,medical clomipramine is less well tolerated than the SSRIs, it was given a recommendation grade of 2 (moderate risk benefit ratio), while the SSRIs received the highest recommendation grade 1 (good risk:benefit ratio). As for citalopram, only one positive double-blind, placebo-controlled study was published, and only a recommendation grade Inhibitors,research,lifescience,medical of 3 (limited evidence from controlled studies) was given. This WFSBP guideline mentions that usually lower response rates are achieved in OCD in comparison with other anxiety disorders, and that sometimes only partial remission is achieved. As a rule, somewhat higher doses are used for these drugs in OCD than for other anxiety disorders, higher doses being associated with greater efficacy in some, but not all, evaluations. Inhibitors,research,lifescience,medical In several longterm and relapse-prevention studies, SRIs were shown to be superior
to placebo, pointing to the requirement of long-term treatment of OCD. According to a systematic review on all long-term, placebo-controlled trials with SSRIs in OCD,25 the likelihood of relapse during 24 to 52 weeks of treatment was significantly lower on an SSRI than with placebo. Inhibitors,research,lifescience,medical Thus, successful treatment with SSRIs should be maintained at the maximal effective dose for at least 12 months. An extensive display of the many acute Inhibitors,research,lifescience,medical treatment studies on SSRIs versus placebo, different doses of SSRIs, SSRIs versus other SSRIs, clomipramine versus placebo, SSRIs versus clomipramine, SSRIs versus placebo, or clomipramine for continuation
treatment and SSRIs vs placebo or clomipramine for relapse-prevention treatment can also be found in the guidelines on core interventions in the treatment no of OCD of the National Institute for Health and Clinical Excellence (NICE) of the British Psychological Society and the Royal College of Psychiatrists.21 According to these guidelines, the initial pharmacological treatment in adults with OCD should be one of the following SSRIs: fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram. Of note, studies on the efficacy of escitalopram in OCD were published only later.26 A current Cochrane review of placebo-controlled SSRI trials in OCD, comprising 17 studies with 3097 participants, also showed efficacy for all SSRIs included (citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline).27 The authors detected no statistical differences in short-term therapeutic action among the individual SSRIs.