EFFICACY OF DRUG-TREATMENT IN OBSESSIVE-COMPULSIVE DISORDER - A METAANALYTIC REVIEW

Background. A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-ana lytic approach. Method. Randomised double-blind clinical trials of ant idepressant drugs, carried out among patients with OCD and published i n peer-reviewed journals between 1975 and May 1994, were selected toge ther with three studies currently in press. Forty-seven trials were lo cated by searching the Medline and Excerpta Medica - psychiatry data b ases, scanning psychiatric and psychopharmacological journals, consult ing recent published reviews and bibliographies, contacting pharmaceut ical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditi ons or at the latest reported point of time during this treatment peri od. For each trial, effect sizes were computed for all available outco me measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; an xiety; global clinical improvement; psychosocial adjustment; and physi cal symptoms. Results. Clomipramine was superior to placebo in reducin g both obsessive-compulsive symptoms considered together (g = 1.3 I; 9 5% Cl = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% Cl = 0.36 t o 1.42) and compulsions (g = 0.79; 95% Cl = 0.34 to 1.24) taken separa tely. Also, selective serotonin re-uptake inhibitors (SSRIs) as a clas s were superior to placebo, weighted mean g being respectively 0.47 (9 5% Cl = 0.33 to 0.61), 0.54 (95% Cl = 0.34 to 0.74) and 0.52 (95% Cl = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS th e increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% an d 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline resp ectively, the trials testing clomipramine against fluoxetine and fluvo xamine showed similar therapeutic efficacy between these drugs. Finall y, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties. Conclusion. Antidepr essant drugs are effective in the short-term treatment of patients suf fering from OCD; although the increase in improvement rate over placeb o was greater for clomipramine than for SSRIs, direct comparison betwe en these drugs showed that they had similar therapeutic efficacy on ob sessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serot onergic properties; concomitant high levels of depression at the outse t did not seem necessary for clomipramine and for SSRIs to improve obs essive-compulsive symptoms.