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Paroxetine versus Clomipramine in the Treatment of Obsessive–Compulsive Disorder

  • Joseph Zohar (a1), Rajinder Judge (a2) and Ocd Paroxetine Study Investigators
Abstract
Background

The aim was to assess the effect of a flexible dose of paroxetine, compared with clomipramine and placebo, in obsessive-compulsive disorder (OCD).

Method

In a multinational randomised study, 406 subjects with OCD of at least six months duration received double-blind mediation for up to 12 weeks. Doses were adjusted according to therapeutic effect and side-effects. Primary efficacy measures were the Yale–Brown Obsessive–Compulsive Scale and the National Institute of Mental Health Obsessive–Compulsive Scale. Secondary efficacy measures were the Montgomery–åsberg Depression Rating Scale, Symptom Check-List (90), Clinical Global Impression, and Patients' Global Evaluation.

Results

Paroxetine was significantly more effective than placebo, and of comparable efficacy to clomipramine. Paroxetine had significantly superior tolerability to clomipramine on three measures: CGI efficacy index, anticholinergic adverse events, and adverse events leading to withdrawal.

Conclusion

Paroxetine is as effective as clomipramine in the treatment of OCD. The comparable efficacy and better tolerability of paroxetine suggest that it would be an appropriate treatment for OCD.

Copyright
Corresponding author
Rajinder Judge, SmithKline Beecham Pharmaceuticals, New Frontiers Science Park, Third Avenue, Harlow, Essex CM19 5AW, UK
References
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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Arminen, S. L., Ikonen, U., Pulkkinen, P., et al (1994) A 12-week double-blind multi-centre study of paroxetine and imipramine in hospitalized depressed patients. Acta Psychiatrica Scandinavica, 89, 382389.
Chouinard, G., Goodman, W., Greist, J., et al (1990) Results of a double-blind placebo-controlled trial of a new serotonin reuptake inhibitor, sertraline, in the treatment of obsessive–compulsive disorder. Psychopharmacology Bulletin, 26, 279284.
Dunbar, G. C., Cohn, J. B., Fabre, L. F., et al (1991) A comparison of paroxetine, imipramine and placebo in depressed out-patients. British Journal of Psychiatry, 159, 394398.
Fineberg, N. A., Bullock, T., Montgomery, D. B., et al (1992) Serotonin reuptake inhibitors are the treatment of choice in obsessive compulsive disorder. International Clinical Psychopharmacology, 7 (suppl. 1), 4347.
Fontaine, R. & Chouinard, G. (1985) Fluoxetine in the treatment of obsessive–compulsive disorder. Progress in Neuropsychopharmacology and Biological Psychiatry, 9, 605608.
Freeman, C. P. L., Trimble, M. R., Deakin, F. W., et al (1994) Fluvoxamine versus clomipramine in the treatment of obsessive compulsive disorder, a multicenter, randomised, double-blind, parallel group comparison. Journal of Clinical Psychiatry, 55, 301305.
Goodman, W. K., Price, L. H. & Rasmussen, S. A., et al (1989) The Yale–Brown Obsessive Compulsive Scale. Archives of General Psychiatry, 46, 10061011 & 1012–1016.
Goodman, W. K., McDougle, C. J. & Price, L. H. (1992) Pharmacotherapy of obsessive compulsive disorder. Journal of Clinical Psychiatry, 53 (suppl. 4), 2937.
Goodman, W. K., McDougle, C. J., Barr, L. C., et al (1993) Biological approaches to treatment-resistant obsessive compulsive disorder. Journal of Clinical Psychiatry, 54 (suppl. 6), 1626.
Greist, J. H. (1992) An integrated approach to treatment of obsessive compulsive disorder. Journal of Clinical Psychiatry, 53 (suppl. 4), 3841.
Greist, J. H., Jefferson, J. W., Kobak, K. A., et al (1995a) Efficacy and tolerability of serotonin transport inhibitors in obsessive–compulsive disorder. A meta-analysis. Archives of General Psychiatry, 52, 5360.
Greist, J. H., Chouinard, G., Duboff, E., et al (1995b) Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive–compulsive disorder. Archives of General Psychiatry, 52, 289295.
Jackson, C. W., Morton, W. A. & Lydiard, R. B. (1994) Pharmacologic management of obsessive–compulsive disorder. Southern Medical Journal, 87, 310321.
McTavish, D. & Benfield, P. (1990) Clomipramine: an overview of its pharmacological properties and a review of its therapeutic use in obsessive compulsive disorder and panic disorder. Drugs, 39, 136153.
Montgomery, S. A. & Åsberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
Greist, J. H., McIntyre, A., Osterheider, M., et al (1993) A double-blind placebo-controlled study of fluoxetine in patients with DSM–III–R obsessive–compulsive disorder. The Lilly European OCD Study Group. European Neuropsychopharmacology, 3, 143152.
Murphy, D. L., Zohar, J., Benkelfat, C., et al (1989) Obsessive–compulsive disorder as a 5-HT subsystem-related behavioural disorder. British Journal of Psychiatry, 155 (suppl. 8), 1524.
Parloff, M. B., Kelman, H. C. & Frank, J. D. (1954) Comfort, effectiveness and self-awareness as criteria of improvement in psychotherapy. American Journal of Psychiatry, 111, 343351.
Pigott, T. A., Pato, M. T., Bernstein, S. E., et al (1990) Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive–compulsive disorder. Archives of General Psychiatry, 47, 926932.
Rasmussen, S. A. & Eisen, J. L. (1992) The epidemiology and clinical features of obsessive compulsive disorder. Psychiatric Clinics of North America, 15, 743758.
Sheehan, D., Dunbar, G. C. & Fuell, D. (1992) The effect of paroxetine on anxiety and agitation associated with depression. Psychopharmacology Bulletin, 2, 139143.
Stuppaeck, C. H., Geretsegger, C., Whitworth, A. B., et al (1994) A multicenter double-blind trial of paroxetine versus amitriptyline in depressed inpatients. Journal of Clinical Psychopharmacology, 14, 241246.
Tollefson, G. D., Rampey, A.H. Jr., Potvin, J. H., et al (1994) A multicenter investigation of fixed-dose fluoxetine in the treatment of obsessive–compulsive disorder. Archives of General Psychiatry, 51, 559567.
Turner, S. M., Jacob, R. G., Beidel, D. C., et al (1985) Fluoxetine treatment of obsessive–compulsive disorder. Journal of Clinical Psychopharmacology, 5, 207212.
Weissman, M. M., Bland, R. C., Canino, G. J., et al (1994) The cross national epidemiology of obsessive compulsive disorder. Journal of Clinical Psychiatry, 55 (suppl. 3), 510.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Paroxetine versus Clomipramine in the Treatment of Obsessive–Compulsive Disorder

  • Joseph Zohar (a1), Rajinder Judge (a2) and Ocd Paroxetine Study Investigators
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