High-Dose Sertraline Strategy for Nonresponders to Acute Treatment for Obsessive-Compulsive Disorder

Ninan, Philip T.; Koran, Lorrin M.; Kiev, Ari; Davidson, Jonathan; Rasmussen, Steven A.; Zajecka, John; Robinson, Delbert G.; Crits‐Christoph, Paul; Mandel, Francine S.; Austin, Carol D.

doi:10.4088/jcp.v67n0103

Cited by 211 publications

(55 citation statements)

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“…In a double-blind study comparing sertraline 200 mg/day with higher doses Addition of l-tryptophan to clomipramine or to SSRI'pindolol Blier and Bergeron 1996;Rasmussen 1984 Yes (C1) Addition of inositol to an SSRI Seedat and Stein 1999 No (E) Electroconvulsive therapy Gruber 1971;Husain et al 1993;Khanna et al 1988;Maletzky et al 1994;Mellman and Gorman 1984 Yes (C1) OCD in children, treatment-resistant Adding clonazepam or risperidone to an SSRI Leonard et al 1994 Yes (C2) Adding risperidone to an SSRI Fitzgerald et al 1999 Yes (C2) (250Á400 mg/day), greater symptom improvement was seen in the high-dose group (Ninan et al 2006). In an open-label study, patients who did not respond to escitalopram 20 mg/day showed improvement after a dosage increase (maximum 50 mg/day) (Rabinowitz et al 2008).…”

Section: Treatment-resistantmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

718

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Section: Treatment-resistantmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

718

410

View full text Add to dashboard Cite

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“…Several studies have reported that supratherapeutic doses of SSRIs (e.g., up to 50 mg/day for escitalopram and up to 400 mg/day for sertraline) are connected with significantly higher improvement in OCD symptoms. [112][113][114] However, this method does not appear to be a desirable first-step treatment in the pregnancy period, because its potential adverse effects on the fetus are unknown and studies regarding its effectiveness in unresponsive patients is inadequate. If administration of such high doses becomes necessary, the pregnant women and exposed fetus must be observed closely.…”

Section: Second-line Haloperidolmentioning

confidence: 99%

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Uğuz

2015

Rev. Bras. Psiquiatr.

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Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.

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“…Furthermore, increasing SSRI doses have been suggested to be an effective strategy in adults with OCD. One RCT in SSRI non-responders showed the benefits of 400 mg of sertraline compared to 200 mg daily [76]. Indeed, as stated in the most recent expert guidelines, these strategies are off-label, and with the exception of riluzole, they are at most based on a limited number of case reports [1].…”

Section: Other Possible Medicationsmentioning

confidence: 99%

Evidence-Based Treatments in Treatment-Naïve and Treatment-Resistant Pediatric Obsessive-Compulsive Disorder

Skarphéðinsson

Ivarsson

2015

Curr Behav Neurosci Rep

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Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling, and common disorder. In this paper, we describe evidence-based treatments in treatment-naïve and treatment-refractory pediatric OCD patients. We conducted a PubMed search to identify randomized controlled trials, reviews, and expert guidelines. The evidence for cognitive behavior therapy (CBT) and specific serotonin reuptake inhibitors (SSRIs) among treatment-naïve patients is substantial and shows that both treatments are effective. Head-to-head trials in pediatric OCD only show that CBT is significantly more effective than SSRI. The evidence among CBT and SSRI non-responders is limited. One trial among CBT non-responders showed that both continued CBT and switching to an SSRI are effective strategies. Likewise, one trial among SSRI non-responders showed that augmenting with CBT is necessary. Evidence of treatments for treatment-refractory pediatric OCD is lacking. We describe the treatments available and evidence from studies of adult OCD. Evidence for emerging treatments such as modifying CBT and glutamatergic drugs is also described.

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High-Dose Sertraline Strategy for Nonresponders to Acute Treatment for Obsessive-Compulsive Disorder

Cited by 211 publications

References 0 publications

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Evidence-Based Treatments in Treatment-Naïve and Treatment-Resistant Pediatric Obsessive-Compulsive Disorder

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