Obsessive Compulsive Disorder

Several multicenter trials find benefit of sertraline over placebo in the acute- and maintenance-phase treatment of OCD in adults. One earlier, smaller study failed to show superiority of sertraline over placebo, perhaps because of the limited sample size (n = 19) or the treatment-resistant characteristics of the cohort (Jenike et al. 1990). Larger-scale studies with diverse patients had differing results. In a 12-week flexible-dose study (Kronig et al. 1999), 167 patients were randomly assigned to placebo or sertraline. Between 53% and 57% of the subjects were male, and the average age was 37-38 years. The mean daily dose of sertraline at endpoint was 165 mg (SD = 55 mg). By week 3, significant differences between drug and placebo emerged. Forty-one percent of patients receiving sertraline and 23% of patients receiving placebo achieved a CGI-I score of 1 or 2 at endpoint.

A fixed-dose study (Greist et al. 1995) also found superior results with three different doses of sertraline, compared with placebo, over 1 year. Three hundred twenty-five subjects with OCD from 11 sites were randomly assigned to 12 weeks of double-blind treatment with one of three fixed doses of sertraline (50, 100, or 200 mg) or placebo after a 1-week washout period. At the end of this period, all treatment responders were offered enrollment in an additional 40 weeks of treatment. Forty percent of sertraline responders versus 26% of placebo responders entered the second phase of the study, a significant difference (P = 0.025). In fact, over the full 52 weeks of the study, subjects treated with sertraline demonstrated significantly greater improvement than subjects given placebo, based on efficacy measures that included the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) (F1,289 = 7.06, P = 0.001), the NIMH-Global Obsessive-Compulsive Scale (NIMH-GOCS) (F1,311 = 11.22, P = 0.0009), the CGI Scale (F1,311 = 8.09, P = 0.005), and the CGI-I (F1,311 = 7.18, P = 0.0007).

Some evidence suggests that higher amounts of sertraline may be helpful for patients who fail to respond at standard dosages. In one study, 66 patients with OCD who failed to respond to sertraline therapy at doses of 200 mg/daily after 16 weeks of treatment were randomly assigned to continue on the same dose for an additional 12 weeks or to increase their dose to 250-400 mg/daily (Ninan et al. 2006). At the end of the trial, those receiving higher doses had greater improvement in Y-BOCS scores, though responder rates (at least a 25% decrease in Y-BOCS scores and a CGI-I rating s3) between the two groups were similar.

Other studies supporting the utility of sertraline in OCD include head-to-head comparison studies with other antidepressants (Bergeron et al. 2002; Bisserbe et al. 1995; Hoehn-Saric et al. 2000). In a comparison of lower-dose sertraline with cognitive-behavioral group therapy, both treatments were shown to be efficacious, though OCD patients treated with group therapy had greater reduction in symptoms (Sousa and Isolan 2006).

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