A Double Blind Comparison of Venlafaxine and Paroxetine in Obsessive-Compulsive Disorder

Abstract

While the usefulness of clomipramine and selective serotonin reuptake inhibitors (SSRIs) in obsessive-compulsive disorder (OCD) has been established, the efficacy of serotonin-norepinephrine reuptake inhibitors remains to be determined. This report describes the first randomized double-blind comparison study of an SNRI in patients with obsessive-compulsive disorder. The current study compares the efficacy and tolerability of venlafaxine with paroxetine. One hundred and fifty patients with primary OCD according to DSM-IV criteria were randomly assigned in a 12-week double-blind trial to receive dosages titrated upward to 300 mg/d of venlafaxine (n = 75) or 60 mg/d of paroxetine (n = 75). Primary efficacy was assessed by the change from baseline on the Yale-Brown obsessive-compulsive scale (Y-BOCS). Other assessments throughout the trial included the Hamilton depression rating scale, and the Hamilton anxiety rating scale. An intent-to-treat, last-observation-carried-forward analysis demonstrated a mean decrease on the Y-BOCS of 7.2 +/- 7.5 in the venlafaxine group and of 7.8 +/- 5.4 in the paroxetine group. In both treatment groups, a responder rate (decrease > 35% on the Y-BOCS) of approximately 40% was found. There were no significant differences between venlafaxine and paroxetine with regard to response or responder rates. The incidence of adverse events for venlafaxine and paroxetine was comparable. The most common side effects for venlafaxine were somnolence, insomnia, a dry mouth, and sweating; and for paroxetine somnolence, sweating, nausea, and headache. These results show that venlafaxine was equally effective to paroxetine in treating patients with OCD. Venlafaxine may be a useful therapy for obsessive-compulsive patients, but is not superior to SSRIs.

Symptom Dimensions in Obsessive-Compulsive Disorder: Factor Analysis on a Clinician-Rated Scale and a Self-Report Measure

“…The sample was drawn from patients who intended to participate in a treatment study [17]. Subjects were female or male outpatients, aged between 18 and 65 years, who were diagnosed with primary OCD according to the DSM-IV criteria.…”

Obsessive–compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults

“…There have been no placebo-controlled studies demonstrating efficacy for venlafaxine in OCD. Moreover, Denys et al (2003) showed that whereas switching from venlafaxine to an SSRI improved outcomes in non-responders, the opposite was not true.…”

Obsessive-Compulsive Disorder: Diagnosis, Epidemiology, Etiology, and Treatment

“…Mirtazapine has been found to accelerate the response to citalopram in a singleblind randomized augmentation study (135) and showed some efficacy in a discontinuation trial (136). Venlafaxine has shown mixed results, with no difference from placebo in one doubleblind, placebo-controlled study (137), yet its efficacy was relatively equal to that of paroxetine (138,139) and clomipramine (140) in double-blind comparator studies.…”