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Meta-Analysis
. 2008 Jan 23;2008(1):CD001765.
doi: 10.1002/14651858.CD001765.pub3.

Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD)

G M Soomro  1 , D Altman, S Rajagopal, M Oakley-Browne
Affiliations
Meta-Analysis

Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD)

G M Soomro et al. Cochrane Database Syst Rev. .

Abstract

Background: Obsessive compulsive disorder is a common and disabling disorder. A significant proportion of patients manifest a chronic course. Individual randomised controlled trials (RCTs) have shown that selective serotonin re-uptake inhibitors (SSRIs) are effective in this condition. Previous systematic reviews or meta-analyses summarising the evidence are methodologically problematic or limited in the scope of their analysis.

Objectives: To examine the efficacy and adverse effects of serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) in adults.

Search strategy: CCDANCTR-Studies and CCDANCTR-References were searched on 12/11/2007. Reference lists were checked. Experts in the field were contacted.

Selection criteria: All RCTs and quasi-RCTs examining the efficacy of SSRIs compared with placebo for OCD in adults were eligible for inclusion.

Data collection and analysis: Selection of studies and data extraction were carried out by two review authors independently, and quality assessment of studies was undertaken. Data analysis was conducted using Review Manager software. Summary measures were produced using the weighted mean difference (WMD) for continuous data and relative risk (RR) for dichotomous data, with 95% confidence intervals (CI). SSRIs were examined as an overall group of drugs, and as individual drugs.

Main results: Seventeen studies were included in the review, involving 3097 participants. Based on all 17 studies, SSRIs as a group were more effective than placebo in reducing the symptoms of OCD between 6 and 13 weeks post-treatment, measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS) (WMD -3.21, 95% CI -3.84 to -2.57). The WMD for individual SSRI drugs were similar and not statistically different. Based on 13 studies (2697 participants), SSRIs were more effective than placebo in achieving clinical response at post-treatment (RR 1.84, 95% CI 1.56 to 2.17). The pooled RR was shown to be similar between individual SSRI drugs. Although reported adverse effects data were more limited, with few exceptions, the overall and individual adverse effects for the different SSRIs were always worse than for placebo and, in the majority of cases, the difference was statistically significant. Nausea, headache and insomnia were always reported amongst the most common adverse effects in trials of each of the drugs.

Authors' conclusions: SSRIs are more effective than placebo for OCD, at least in the short-term, although there are differences between the adverse effects of individual SSRI drugs. The longer term efficacy and tolerability of different SSRI drugs for OCD has yet to be established.

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Conflict of interest statement

G Mustafa Soomro: None stated D Altman: None stated S Rajagopal: None stated M Oakley‐Browne: None stated

Figures

1
1
Funnel plot 1.
2
2
Funnel plot 2.
1.1
1.1. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 1 YBOCS reduction for all SSRI drugs.
1.2
1.2. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 2 YOBCS reduction (individual SSRI drugs).
1.3
1.3. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 3 Responders ITT for all SSRI drugs.
1.4
1.4. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 4 Responders ITT (indvidual SSRI drugs).
1.5
1.5. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 5 YBOCS reduction (mean duration of OCD).
1.6
1.6. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 6 YBOCS reduction (severe secondary depression).
1.7
1.7. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 7 YBOCS reduction (duration of trial).
1.8
1.8. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 8 YBOCS reduction (proportion of discontinuers).
1.9
1.9. Analysis
Comparison 1 SSRIs versus Placebo ‐ efficacy using YBOCS, Outcome 9 Responders per completers (proportion of discontinuers).
2.1
2.1. Analysis
Comparison 2 SSRIs versus placebo ‐ efficacy using NIMH‐OC scale or other measures (individual SSRI drugs), Outcome 1 SSRI versus placebo ‐efficacy using NIMH‐OCS only.
2.2
2.2. Analysis
Comparison 2 SSRIs versus placebo ‐ efficacy using NIMH‐OC scale or other measures (individual SSRI drugs), Outcome 2 SSRI v. placebo on NIMH‐OCS or other scales (CGI ‐S for Montgomery 93 & Dominguez 91, & CGI‐I Hollander 03).
3.1
3.1. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 1 Citalopram ‐ overall adverse effects.
3.2
3.2. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 2 Citalopram ‐ nausea, headache and insomnia.
3.3
3.3. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 3 Citalopram ‐ sexual side effects.
3.4
3.4. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 4 Fluoxetine ‐ nausea, headache, insomnia and anxiety.
3.5
3.5. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 5 Fluvoxamine ‐ overall adverse effects.
3.6
3.6. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 6 Fluvoxamine ‐ insomnia, nausea, fatigue, headache, somnolence and asthenia.
3.7
3.7. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 7 Fluvoxamine ‐ sexual side effects.
3.8
3.8. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 8 Paroxetine ‐ overall adverse effects.
3.9
3.9. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 9 Paroxetine ‐ asthenia, headache, insomnia, somnolence, nausea and constipation.
3.10
3.10. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 10 Paroxetine ‐ sexual adverse effects.
3.11
3.11. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 11 Sertraline ‐ overall adverse effects.
3.12
3.12. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 12 Sertraline ‐ nausea, insomnia, dyspepsia, constipation, sedation, forgetfulness, headache and diarrhoea.
3.13
3.13. Analysis
Comparison 3 SSRIs versus Placebo ‐ adverse effects, Outcome 13 Sertraline ‐ sexual side effects.
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References

References to studies included in this review

Chouinard 1990 {published data only}
    1. Chouinard G, Goodman W, Greist J, Jenike M, Rasmussen S, White K, et al. Results of a double‐blind placebo controlled trial of a new serotonin uptake inhibitor, sertraline, in the treatment of obsessive‐compulsive disorder. 1990 Psychopharmacology Bulletin;26(3):279‐84. - PubMed
    1. Clary CM. Sertraline in the treatment of obsessive‐compulsive disorder. American Family Physician 1999;59(1):49. - PubMed
Dominguez 1991 {published data only}
    1. Ackerman DL, Greenland S, Bystritsky A. Clinical characteristics of response to fluoxetine treatment of obsessive‐compulsive disorder. Journal of Clinical Psychopharmacology 1998;18(3):185‐92. - PubMed
    1. Ackerman DL, Greenland S, Bystritsky A. Side effects as predictors of drug response in obsessive‐compulsive disorder. Journal of Clinical Psychopharmacology 1999;19(5):459‐65. - PubMed
    1. Dominguez RA. Serotonergic antidepressants and their efficacy in obsessive compulsive disorder. Journal of Clinical Psychiatry 1992;53 Suppl 10:56‐9. - PubMed
    1. Dominguez RA, Jacobson AF, Goldstein BJ, et al. Fixed‐dose of fluoxetine in obsessive‐compulsive disorder. Journal of Clinical Pharmacology 1991;31:843.
    1. Tollefson GD, Birkett M, Koran L, Genduso L. Continuation treatment of OCD: double‐blind and open‐label experience with fluoxetine. Journal of Clinical Psychiatry 1994;55 Suppl:69‐76. - PubMed
Goodman 1989 {published data only}
    1. Goodman WK, Price LH, Rasmussen SA, Delgado PL, Heninger GR, Charney DS. Efficacy of fluvoxamine in obsessive‐compulsive disorder. A double‐blind comparison with placebo. Archives of General Psychiatry 1989;46(1):36‐44. - PubMed
Goodman 1996 {published data only}
    1. Goodman WK, Kozak MJ, Liebowitz M, White KL. Treatment of obsessive‐compulsive disorder with fluvoxamine: A multicentre, double‐blind, placebo‐controlled trial. International Clinical Psychopharmacology 1996;11(1):21‐9. - PubMed
Greist 1992b {published data only}
    1. Clary CM. Sertraline in the treatment of obsessive‐compulsive disorder. American Family Physician 1999;59(1):49. - PubMed
    1. Greist J. Double‐blind comparison of three doses of sertraline and placebo in the treatment of outpatients with obsessive compulsive disorder. Clinical Neuropharmacology 1992;15(1 Pt B):316.
    1. Greist J, Chouinard G, DuBoff E, Halaris A, Kim SW, Koran L, et al. Double‐blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive‐compulsive disorder. Archives of General Psychiatry 1995;52(4):289‐95. - PubMed
    1. Greist JH, Jefferson JW, Kobak KA, Chouinard G, DuBoff E, Halaris A, et al. A 1 year double‐blind placebo‐controlled fixed dose study of sertraline in the treatment of obsessive‐compulsive disorder. International Clinical Psychopharmacology 1995;10(2):57‐65. - PubMed
    1. Rasmussen S, Hackett E, DuBoff E, Greist J, Halaris A, Koran L, et al. Long‐term sertraline treatment of obsessive compulsive disorder: A 2 year study.. 8th ECNP (European College of Neuropsychopharmacology) Congress, Venice, Italy. 1995.
Hollander 2002 {published data only}
    1. Hollander E, Kaplan A, Schmeidler J, Yang H, Li D, Koran LM, et al. Neurological soft signs as predictors of treatment response to selective serotonin reuptake inhibitors in obsessive‐compulsive disorder. Journal of Neuropsychiatry and Clinical Neurosciences 2005;17(4):472‐7. - PubMed
    1. Hollander E, Koran LM, Goodman WK, Greist JH, Ninan PT, Yang H, et al. A double‐blind, placebo‐controlled study of the efficacy and safety of controlled‐release fluvoxamine in patients with obsessive‐compulsive disorder. Journal of Clinical Psychiatry 2003;64(6):640‐7. - PubMed
    1. Hollander E, Yang H, Li D, Barbato LM, Gerritsen van der Hoop R. Fluvoxamine controlled release in the treatment of adult outpatients with obsessive‐compulsive disorder. International Journal of Neuropsychopharmacology 5[Suppl 1], 133. 2002 2002;5 Suppl 1:133.
Hollander 2003 {published data only}
    1. Hollander E, Allen A, Steiner M, Wheadon DE, Oakes R, Burnham DB. Acute and long‐term treatment and prevention of relapse of obsessive‐compulsive disorder with paroxetine. Journal of Clinical Psychiatry 2003;64(9):1113‐21. - PubMed
Jenike 1990a {published data only}
    1. Jenike MA, Hyman S, Baer L, Holland A, Minichiello WE, Buttolph L, et al. A controlled trial of fluvoxamine in obsessive‐compulsive disorder: implications for a serotonergic theory. American Journal of Psychiatry 1990;147(9):1209‐15. - PubMed
Jenike 1990b {published data only}
    1. Jenike MA, Baer L, Summergrad P, Minichiello WE, Holland A, Seymour R. Sertraline in obsessive‐compulsive disorder: a double‐blind comparison with placebo. American Journal of Psychiatry 1990;147(7):923‐8. - PubMed
    1. Jenike MA, Baer L. Erratum: Sertraline in obsessive‐compulsive disorder: a double‐blind comparison with placebo. American Journal of Psychiatry 1990;147(10):1393. - PubMed
Jenike 1997 {published data only}
    1. Jenike MA, Baer L, Minichiello WE, Rauch SL, Buttolph ML. Placebo‐controlled trial of fluoxetine and phenelzine for obsessive‐compulsive disorder. American Journal of Psychiatry 1997;154(9):1261‐4. - PubMed
Kamijima 2004 {published data only}
    1. Kamijima K, Murasaki M, Asai M, Higuchi T, Nakajima T, Taga C, et al. Paroxetine in the treatment of obsessive‐compulsive disorder: randomized double‐blind, placebo‐controlled study in Japanese patients. Psychiatry and Clinical Neurosciences 2004;58:427‐33. - PubMed
Kasper 1999 {published data only}
    1. Kasper S, Note ID, Montgomery S. Citalopram is effective in obsessive compulsive disorder: results of a double‐blind, placebo‐controlled trial. Journal of the European College of Neuropsychopharmacology 1999;9 Suppl 5:217.
    1. Montgomery SA, Kasper S, Stein DJ, Bang Hedegaard K, Lemming OM. Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive‐compulsive disorder. International Clinical Psychopharmacology 2001;16(2):75‐86. - PubMed
    1. Stein DJ, Montgomery SA, Kasper S, Tanghoj P. Predictors of response to pharmacotherapy with citalopram in obsessive‐compulsive disorder. International Clinical Psychopharmacology 2001;16(6):357‐61. - PubMed
Kronig 1999 {published data only}
    1. Kronig MH, Apter J, Asnis G, Bystritsky A, Curtis G, Ferguson J, et al. Placebo‐controlled, multicenter study of sertraline treatment for obsessive‐compulsive disorder. Journal of Clinical Psychopharmacology 1999;19(2):172‐6. - PubMed
Montgomery 1993c {published data only}
    1. Meszaros K, Zitterl W, Dossenbach M, Zitterl‐Eglseer K, Klech H. A double‐blind, placebo‐controlled trial of fluoxetine in patients with obsessive‐compulsive disorder in Austria. 8th ECNP (European College of Neuropsychopharmacology) Congress, Venice, Italy. 1995.
    1. Montgomery SA, McIntyre A, Osterheider M, Sarteschi P, Zitterl W, Zohar J, et al. A double‐blind, placebo‐controlled study of fluoxetine in patients with DSM‐III‐R obsessive‐compulsive disorder. European Neuropsychopharmacology 1993;3(2):143‐52. - PubMed
    1. Zitterl W, Meszaros K, Hornik K, Twaroch T, Dossenbach M, Zitterl‐Eglseer K, et al. Efficacy of fluoxetine in Austrian patients with obsessive‐compulsive disorder. Wiener Klinische Wochenschrift 1999;111(11):439‐42. - PubMed
Nakajima 1996 {published data only}
    1. Nakajima T, Kudo Y, Yamashita I. Clinical usefulness of Fluvoxamine Maleate (SME3110), a selective serotonin reuptake inhibitor, in the treatment of obsessive compulsive disorder: A dopuble blind, placebo‐controlled study investigating the therapeutic dose range and the efficacy of SME3110. Journal of clinical therapeutics & medicine (Rinshou Iyaku) 1996;12(3):409‐37.
Ushijima 1997 {published data only}
    1. Ushijima S, Kamijima K, Asai M, Murasaki M, Nakajima T, Kudo Y. Clinical evaluation of sertraline hydrochloride, a selective serotonin reuptake inhibitor in the treatment of obsessive‐ compulsive disorder: A double blind placebo controlled trial. Japanese Journal of Neuropsychopharmacology 1997;19(6):603‐23.
Zohar 1996 {published data only}
    1. Humble M, Bejerot S, Bergqvist PB, Bengtsson F. Reactivity of serotonin in whole blood: Relationship with drug response in obsessive‐compulsive disorder. Biological Psychiatry 2001;49(4):360‐8. - PubMed
    1. Zohar J, Judge R. Paroxetine versus clomipramine in the treatment of obsessive‐compulsive disorder. British Journal of Psychiatry 1996;169:468‐74. - PubMed

References to studies excluded from this review

Ansseau 1996 {published data only}
    1. Ansseau MM. Serotonergic antidepressants in obsessive personality. American Psychiatric Association, 149th Annual Meeting. 1996.
Beasley 1992 {published data only}
    1. Beasley CM Jr, Potvin JH, Masica DN, Wheadon DE, Dornseif BE, Genduso LA. Fluoxetine: no association with suicidality in obsessive‐compulsive disorder. Journal of Affective Disorders 1992;24(1):1‐10. - PubMed
Cottraux 1990 {published data only}
    1. Cottraux J, Messy P, Marks IM, Mollard E, Bouvard M. Predictive factors in the treatment of obsessive‐compulsive disorders with fluvoxamine and/or behaviour therapy. Behavioural Psychotherapy 1993;21(1):45‐50.
    1. Cottraux J, Mollard E, Bouvard M, Marks I. Exposure therapy, fluvoxamine, or combination treatment in obsessive‐compulsive disorder: one‐year followup. Psychiatry Research 1993;49(1):63‐75. - PubMed
    1. Cottraux J, Mollard E, Bouvard M, Marks I, Sluys M, Nury AM, et al. A controlled study of fluvoxamine and exposure in obsessive‐compulsive disorder. International Clinical Psychopharmacology 1990;5(1):17‐30. - PubMed
George 1991 {published data only}
    1. George MS, Trimble MR. Dystonic reaction associated with fluvoxamine. Journal of Clinical Psychopharmacology 1993;13(3):220‐1. - PubMed
Greist 1990 {published data only}
    1. Greist JH, Jefferson JW, Rosenfeld R, Gutzmann LD, March JS, Barklage NE. Clomipramine and obsessive compulsive disorder: a placebo‐controlled double‐blind study of 32 patients. Journal of Clinical Psychiatry 1990;51(7):292‐7. - PubMed
Hohagen 1998 {published data only}
    1. Hohagen F, Winkelmann G, Rasche‐Raeuchle H, Hand I, Konig A, Muenchau N. Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo: Results of a multicentre study. British Journal of Psychiatry. Supplement 1998;35:71‐8. - PubMed
Koran 1996 {published data only}
    1. Koran LM, Cain JW, Dominguez RA, Rush AJ, Thiemann S. Are fluoxetine plasma levels related to outcome in obsessive‐compulsive disorder?. American Journal of Psychiatry 1996;153(11):1450‐4. - PubMed
Koran 1999 {published data only}
    1. Koran LM, Hackett E, Rubin A, Wolkow R, Robinson D. Efficacy of sertraline in the long‐term treatment of obsessive‐compulsive disorder. American Journal of Psychiatry 2002;159(1):88‐95. - PubMed
Mallya 1993 {published data only}
    1. Mallya G, White K, & Gunderson C. Is there a serotonergic withdrawal syndrome?. Biological Psychiatry 1993;33(11‐2):851‐2. - PubMed
Peter 1997 {published data only}
    1. Peter H, Tabrizian S, & Hand IE. Serum cholesterol in patents with obsessive compulsive disorder during treatment with behavior therapy and ssri or placebo. International Journal of Psychiatry in Medicine 2000;30(1):27‐39. - PubMed
Romano 1998 {published data only}
    1. Romano S, Goodman W, Tamura R, Gonzales J, Deltito J, DuPont R, et al. Long‐term treatment of obsessive‐compulsive disorder after an acute response: a comparison of fluoxetine versus placebo. Journal of Clinical Psychopharmacology 2001;21(1):46‐52. - PubMed
Turner 1985 {published data only}
    1. Turner SM, Jacob RG, Beidel DC, & Himmelhoch J. Fluoxetine treatment of obsessive‐compulsive disorder. Journal of Clinical Psychopharmacology 1985;5(4):207‐12. - PubMed
Zohar 1994 {published data only}
    1. Zohar J, Kaplan Z, Benjamin J. Compulsive exhibitionism successfully treated with fluvoxamine: a controlled case study. Journal of Clinical Psychiatry 1994;55(3):86‐8. - PubMed

References to studies awaiting assessment

Bolt 1992 {published data only}
    1. Bolt G, Holland R, Vardy A. Fluvoxamine (FL): An effective treatment for obsessive compulsive disorder (OCD). Clinical Neuropharmacology 1992;15 Suppl 1, Pt B:313.
Erzegovesi 2001 {published data only}
    1. Erzegovesi S, Cavallini MC, Cavedini P, Diaferia G, Locatelli M, Bellodi L. Clinical predictors of drug response in obsessive‐compulsive disorder. Journal of Clinical Psychopharmacology 21[5], 488‐92. 2001 2001;21(5):488‐92. - PubMed
Greist 1992a {published data only}
    1. Greist JH. Fluvoxamine in obsessive compulsive disorder: A multicenter parallel design double‐blind placebo‐controlled trial. Clinical Neuropharmacology 1992;15 Suppl 1, Pt B:310.
Hembree 2003 a {published data only}
    1. Hembree EA, Riggs DS, Kozak MJ, Franklin ME, Foa EB. Long‐term efficacy of exposure and ritual prevention therapy and serotonergic medications for obsessive‐compulsive disorder. CNS Spectrums 2003;8(5):363‐71. - PubMed
Jianxun 1998 {published data only}
    1. Jianxun L, Hu X, Haiying D. Clinical controlled study of paroxetine and clomipramine in treatment of obsessive‐ compulsive disorder. Chinese Journal of Psychiatry 1998;31(4):215‐7.
Mallya 1992 {published data only}
    1. Mallya GK, White K, Waternaux C, Quay S. Short and long term treatment of obsessive compulsive disorder with fluvoxamine. Annals of Clinical Psychiatry 1992;4(2):77‐80.
Nakagawa 2004 {published data only}
    1. Nakagawa A, Nakatani E, Nakao T, Nabeyama M, Yoshizato C, Kudoh A, et al. Behavioral therapy (BT) alone vs BT + fluvoxamine for treatment of obsessive‐ compulsive disorder. 32nd Congress of the British Association for Behavioural and Cognitive Psychotherapies (jointly with the European Association of Behavioural and Cognitive Therapies); 2004 September 7 ‐ 11; Manchester. 2004.
    1. Nakao T, Nakagawa A, Yoshiura T, Nakatani E, Nabeyama M, Yoshizato C, et al. Brain activation of patients with obsessive‐compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study. Biological Psychiatry 2005;57(8):901‐10. - PubMed
    1. Nakatani E, Nakagawa A, Nakao T, Yoshizato C, Nabeyama M, Kudo A, et al. A randomized controlled trial of Japanese patients with obsessive‐compulsive disorder ‐ Effectiveness of behavior therapy and fluvoxamine. Psychotherapy and Psychosomatics 2005;74(5):269‐76. - PubMed
O'Connor 2006 a {published data only}
    1. O'Connor KP, Aardema F, Robillard S, Guay S, Pelissier MC, Todorov C, et al. Cognitive behaviour therapy and medication in the treatment of obsessive‐compulsive disorder. Acta Psychiatrica Scandinavica 2006;113(5):408‐19. - PubMed
Perse 1987 {published data only}
    1. Jefferson JW, Greist JH, Perse TL, Rosenfeld R. Fluvoxamine associated mania/hypomania in patients with obsessive compulsive disorder. Journal of Clinical Psychopharmacology 1991;11(6):391‐2. - PubMed
    1. Perse TL, Greist JH, Jefferson JW, Rosenfeld R, Dar R. Fluvoxamine treatment of obsessive‐compulsive disorder. American Journal of Psychiatry 1987;144(12):1643‐8. - PubMed
Stein 2007 {published data only}
    1. Stein DJ, Andersen EW, Tonnoir B, Fineberg N. Escitalopram in obsessive‐compulsive disorder: A randomized, placebo‐controlled, paroxetine‐referenced, fixed‐dose, 24‐week study. Current Medical Research and Opinion 2007;23(4):701‐11. - PubMed
Wheadon 1993 {published data only}
    1. Black DW, Monahan P, Gable J, Blum N, Clancy G, Baker P. Hoarding and treatment response in 38 nondepressed subjects with obsessive‐compulsive disorder. Journal of Clinical Psychiatry 1998;59(8):420‐5. - PubMed
    1. Black DW, Monahan PO, Clancy GP, Baker PB, Gabel JM. Hoarding predicts poor response in OCD. 150th Annual Meeting of the American Psychiatric Association. San Diego, CA. 1997.
    1. Wheadon DE, Bushnell WD, Steiner MA. A fixed‐dose comparison of 20, 40 or 60 mg paroxetine to placebo in the treatment of obsessive‐compulsive disorder. 32nd Annual Meeting of the American college of Neuropsychopharmacology, Honolulu, HI. 1993.

Additional references

Abramowitz 1997
    1. Abramowitz JS. Effectiveness of psychological and pharmacological treatments for obsessive‐compulsive disorder: a quantitative review. Journal of Consulting and Clincal Psychology 1997;65(1):44‐52. - PubMed
Ackerman 2002
    1. Ackerman DL, Greenland S. Multivariate meta‐analysis of controlled drug studies for obsessive‐compulsive disorder. Journal of Clinical psychopharmacology 2002;22(3):309‐17. - PubMed
Alsobrook 1998
    1. Alsobrook JP, Pauls DL. The genetics of obsessive‐compulsive disorder. In: Jenike MA, Baer L, Minichiello WE editor(s). Obsessive‐compulsive disorders. 3rd Edition. St. Louis, MO: Mosby, 1998.
APA 1994
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM‐IV). 4th Edition. Washington, DC: American Psychiatric Association, 1994.
APA 2000
    1. American Psychiatric Association. Handbook of psychiatric measures. Washington, DC: American Psychiatric Association, 2000.
Baer 1998
    1. Baer L, Minichiello WE. Behavior therapy for obsessive‐compulsive disorder. In: Jenike MA, Baer L, Minichiello WE editor(s). Obsessive‐compulsive disorders. 3rd Edition. St. Louis, MO: Mosby, 1998.
Barr 1993
    1. Barr LC, Goodman WK, Price LH. The serotonin hypothesis of obsessive compulsive disorder. International Clinical Psychopharmacology 1993;8 Suppl 2:79‐82. - PubMed
Bebbington 1998
    1. Bebbington PE. Epidemiology of obsessive‐compulsive disorder. British Journal of Psychiatry 1998;35:2‐6. - PubMed
Beck 1961
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry 1961;4:561‐71. - PubMed
Beck 1988
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 1988;56(893):893‐7. - PubMed
Bucher 1997
    1. Bucher HC, Guyatt GH, Griffith LE, Walter SD. The results of direct and indirect treatment comparisons in meta‐analysis of randomized controlled trials.. Journal of Clinical Epidemiology 1997;50(6):683‐91. - PubMed
Chakrabarti 1993
    1. Chakrabarti S, Kulhara P, Verma SK. The pattern of burden in families of neurotic patients. Social Psychiatry and Psychiatric Epidemiology 1993;28(4):172‐7. - PubMed
Christensen 1987
    1. Christensen H, Hadzi PD, Andrews G, Mattick R. Behavior therapy and tricyclic medication in the treatment of obsessive‐compulsive disorder: a quantitative review. Journal of Consulting and Clinical Psychology 1987;55(5):701‐11. - PubMed
Clarke 2002
    1. Clarke M, Oxman AD. Cochrane Reviewers' Handbook 4.1.5 [updated April 2002]. Oxford: Update Software, 2002.
Cox 1993
    1. Cox BJ, Swinson RP, Morrison B, Lee PS. Clomipramine, fluoxetene, and behavior therapy in the treatment of obsessive‐compulsive disorder: a meta‐analysis. Journal of Behavior Therapy and Experimental Psychiatry 1993;1993(2):149‐53. - PubMed
Deeks 2001
    1. Deeks JJ, Altman DG. Effect measures for meta‐analysis of trials with binary outcomes. In: Egger M, Davey‐Smith G, Altman DG editor(s). Systematic reviews in health care. London: BMJ Books, 2001.
Delgado 1998
    1. Delgado PL, Moreno FA. Different roles for serotonin in anti‐obsessional drug action and the pathophysiology of obsessive‐compulsive disorder. British Journal of Psychiatry. Supplement 1998;35:21‐5. - PubMed
Dickersin 1992
    1. Dickersin K, Min YI, Meinert CL. Factors influencing the publication of research results: follow‐up of applications submitted to two substantial review boards. JAMA 1992;267(3):374‐8. - PubMed
Easterbrook 1991
    1. Easterbrook PJ, Berlin JA, Gopaian R, Matthews DR. Publication bias in clinical research. Lancet 1991;337(8746):867‐72. - PubMed
Ebrahim2001
    1. Ebrahim S. Numbers needed to treat derived from meta‐analysis: pitfalls and cautions. Systematic Reviews in Health Care. London: BMJ Books, 2001. - PubMed
Egger 1997a
    1. Egger M, Davey‐Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Egger 1997b
    1. Egger M, Davey‐Smith G, Phillips AN. Meta‐analysis: Principles and procedures. BMJ 1997;315(7121):1533‐7. - PMC - PubMed
Eisen 1999
    1. Eisen JL, Goodman WK, Keller MB, Warshaw MG, DeMarco LM, Luce DD, et al. Patterns of remission and relapse in obsessive‐compulsive disorder: a 2‐year prospective study. Journal of Clinical Psychiatry 1999;69(5):346‐51. - PubMed
Gelder 2001
    1. Gelder MG, Lopez‐Ibor JJ, Andreasen. New Oxford Textbook of Psychiatry. Oxford: Oxford University Press, 2001.
Goodman 1989a
    1. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale‐Brown obsessive compulsive scale1, Development, use, and reliability. Archives of General Psychiatry 1989;46(11):1006‐11. - PubMed
Goodman 1998
    1. Goodman WK, Price LH. Rating scales for obsessive‐compulsive disorder. In: Jenike MA, Baer L, Minichiello WE editor(s). Obsessive‐compulsive disorders. 3rd Edition. St. Louis, MO: Mosby, 1998.
Greist 1995
    1. Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Serlin RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive‐compulsive disorder. A meta‐analysis. Archive of General Psychiatry 1995;52(1):53‐60. - PubMed
Hamilton 1959
    1. Hamilton M. The assessment of anxiety states by rating. British Journal of Medical Psychology 1959;32:50‐5. - PubMed
Hamilton 1967
    1. Hamilton M. Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychiatry 1967;6(4):278‐96. - PubMed
Hamilton 1969
    1. Hamilton M. Standardised assessment and recording of depressive symptoms. Psychiatry, Neurology and Neurosurgery 1969;72:201‐5. - PubMed
Higgins 2006
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]. http://www.cochrane.org/resources/handbook/hbook.htm (accessed 6th October 2006), 2006.
Hodgson 1977
    1. Hodgson RJ, Rachman S. Obsessive‐compulsive complaints. Behavior Research and Therapy 1977;15(5):389‐95. - PubMed
Jenike 1990c
    1. Jenike MA, Baer L, Greist JH. Clomipramine versus fluoxetine in obsessive‐compulsive disorder: a retrospective comparison of side effects and efficacy. Journal of Clinical Psychopharmacology 1990;10(2):122‐4. - PubMed
Jenike 1990d
    1. Jenike MA, Hyman S, Baer L, Holland A, Minichiello WE, Buttolph L, et al. A controlled trial of fluvoxamine in obsessive‐compulsive disorder: implications for a serotonergic theory. American Journal of Psychiatry 1990;147(9):1209‐15. - PubMed
Juni 2001
    1. Juni P. Assessing the quality of randomised controlled trials. In: Egger, M, Davey‐Smith, G, Altman D.G editor(s). Systematic Reviews in Health Care. London: BMJ publications, 2001. - PMC - PubMed
Karno 1988
    1. Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive‐compulsive disorder in five US communities. Archives of General Psychiatry 1988;45(12):1094‐9. - PubMed
Kim 1990
    1. Kim SW, Dysken MW, Kuskowski M. The Yale‐Brown Obsessive‐Compulsive Scale: a reliability and validity study. Psychiatry Research 1990;34(1):99‐106. - PubMed
Kobak 1998
    1. Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta‐analysis. Psychopharmacology 1998;136(3):205‐16. - PubMed
Moher 1999
    1. Moher D, Cook DJ, Jadad AR, et al. Assessing the quality of reports of randomised trials: implications for conduct of meta‐analysis. Health Technology Assessment 1999;3:12. - PubMed
Moher 2001
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomised trials. Lancet 2001;357(9263):1181‐4. - PubMed
Petitti 1994
    1. Petitti DB. Meta‐analysis, decision analysis and cost‐effectiveness analysis: methods for quantitative review in medicine. Oxford: Oxford University Press, 1994.
Piccinelli 1995
    1. Piccinelli M, Pini S, Bellantuono C, Wilkinson G. Efficacy of drug treatment in obsessive‐compulsive disorder. A meta‐ analytic review. British Journal of Psychiatry 1995;166:424‐43. - PubMed
QAP 1985
    1. Quality Assurance Project. Treatment outlines for the management of obsessive‐compulsive disorders. Australian and New Zealand Journal of Psychiatry 1985;19(3):240‐53. - PubMed
Rasmussen 1989
    1. Rasmussen SA, Eisen JL. Clinical features and phenomenology of obsessive compulsive disorder. Psychiatric Annals 1989;19(1):67‐73.
Rauch 1998a
    1. Rauch SL, Whalen PJ, Dougherty D, Jenike MA. Neurobiologic models of obsessive compulsive disorder. In: Jenike MA, Baer L, Minichiello WE editor(s). Obsessive‐compulsive disorders. 3rd Edition. St. Louis, MO: Mosby, 1998.
Rauch 1998b
    1. Rauch SL, Baxter LR Jr. Neuroimaging in obsessive‐compulsive disorder and related disorders. In: Jenike MA, Baer L, Minichiello WE editor(s). Obsessive‐compulsive disorders. 3rd Edition. St. Louis, MO: Mosby, 1998.
Ravizza 1997
    1. Ravizza L, Maina G, Bogetto F. Episodic and chronic obsessive‐compulsive disorder. Depression and Anxiety 1997;6(4):154‐8. - PubMed
Saxena 1998
    1. Saxena S, Brody AL, Schwartz JM, Baxter LR. Neuroimaging and frontal‐subcortical circuitry in obsessive‐compulsive disorder. British Journal of Psychiatry. Supplement 1998;35:26‐37. - PubMed
Scherer 1994
    1. Scherer RW, Dickersin K, Langenberg P. Full publication of results initially presented in abstracts. A meta‐analysis. JAMA 1994;272(2):158‐62. - PubMed
Skoog 1999
    1. Skoog G, Skoog I. A 40‐year follow‐up of patients with obsessive‐compulsive disorder. Archives of General Psychiatry 1999;56(2):121‐7. - PubMed
Soomro 2003
    1. Soomro GM. Obsessive compulsive disorder. Clinical Evidence 2003;10:1172‐87. - PubMed
Spielberger 1983
    1. Spielberger CD, Gorsuch RL, Luchene R, Vagg PR, Jacobs GA. Manual for the State‐Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press, 1983.
Stein 1995
    1. Stein DJ, Spadaccini E, Hollander E. Meta‐analysis of pharmacotherapy trials for obsessive‐compulsive disorder. International Clinical Psychopharmacology 1995;10(1):11‐8. - PubMed
Steketee 1998
    1. Steketee GS, Frost RO, Rheaume J, Wilhelm S. Cognitive theory and treatment of obsessive‐compulsive disorder. In: Jenike MA, Baer L, Minichiello WE editor(s). Obsessive‐compulsive disorders. 3rd Edition. St. Louis, MO: Mosby, 1998.
Thompson 1994
    1. Thompson SG. Why sources of heterogeneity in meta‐analysis should be investigated. BMJ 1994;309(6965):1351‐5. - PMC - PubMed
van Balkom 1994
    1. Balkom AJ, Oppen P, Vermeulen AW, Dyck R, Nauta MC, Vorst HC. A meta‐analysis on the treatment of obsessive compulsive disorder: a comparison of antidepressants, behavior, and cognitive therapy. Clinical Psychology Review 1994;14:359‐81.
WHO 1992
    1. World Health Organisation. The ICD‐10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organisation, 1992.

MeSH terms