Review: Intravenous anti-obsessive agents: a review

Abstract

Oral antidepressants are currently the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), but response rates can often be low and with delayed onset of therapeutic action. Some reports have suggested that intravenous (i.v.) anti-obsessive agents may have faster onset of action and greater efficacy. A Medline search was conducted for all reports pertaining to the use of i.v. antidepressants for OCD. Search terms included: 'intravenous', 'clomipramine', 'selective serotonin reuptake inhibitor', 'tricyclic', 'citalopram', 'sertraline', 'paroxetine', 'fluvoxamine', 'SSRIs' and 'intravenous antidepressants'. Relevant articles mainly investigated clomipramine (CMI) with one open trial examining citalopram. Intravenous agents appear to be well-tolerated, particularly in those who have failed oral agents, and may act more rapidly to produce initial clinical response, although this advantage is often lost over time. Preliminary evidence suggests subgroups of patients with severe treatment-refractory OCD may benefit from i.v. anti-obsessive agents, CMI and citalopram. Larger, controlled trials are needed for more definitive conclusions.

Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)

“…Intravenous antidepressant administration, including clomipramine and citalopram, was associated with faster response, but eventually, with continued treatment, the result is similar to oral administration [105,106]. Intravenous vs. oral clomipramine was more effective in two double-blind placebo-controlled studies [107,108].…”

The Effect of Intravenous Citalopram on the Neural Substrates of Obsessive-Compulsive Disorder

“…Intravenous serotonin reuptake inhibitors have been shown to be more effective and confer quicker benefits than oral medications when treating OCD symptoms (6-8 weeks for oral versus 4 days-3 weeks for IV treatment). 6 This study represents the first, necessary step in studying the neurobiological mechanism for such benefits. Though the effects observed in the present study were most likely temporary, as participants only received a single dose of citalopram, it may be reasonable to suggest that these effects could persist with a prolonged trial of IV citalopram.…”

“…[3][4][5] However, the effects of intravenous (IV) antiobsessive agents on the neural substrates of OCD have not previously been investigated, even though they are effective at treating refractory patients, are safe and welltolerated, produce greater symptom reductions, and have faster onsets of action than their oral counterparts. 6 To better understand the mechanism of IV antiobsessive agents, the present study evaluated the effect of an intravenously administered SSRI, compared with placebo, on the neural activity of OCD patients and matched controls.…”

A case of severe adolescent obsessive-compulsive disorder treated with inpatient hospitalization, risperidone and sertraline

“…It is well known that SSRIs work rather slowly and can take as much as 6-12 weeks to exert their therapeutic benefit for OCD (Dougherty et al, 2004;Ravindran, Jung & Ravindran, 2010;Thomsen, 1998), a timespan that is considered longer than that for the treatment of depression (Dougherty et al, 2004;Thomsen, 1998). Therefore, it is unlikely this medication had a significant effect in such a short timeframe.…”