High-dose sertraline effective for OCD non-responders
23 Jan 2006

Increasing the dose of sertraline may improve the symptoms of patients with obsessive–compulsive disorder (OCD) who failed to respond to standard acute sertraline treatment, study findings show.

Augmentation strategies to improve treatment response in patients with OCD have involved the combination of different drugs, with many failing to find efficacy.

Philip Ninan, from Emory University School of Medicine in Atlanta, Georgia, USA, and colleagues therefore decided to investigate the potential benefits of increasing the drug dose of an initial treatment, in this case sertraline.

They assigned 66 patients with OCD, who had failed to respond to 16 weeks of treatment with 200 mg/day of sertraline, to either continue on 200 mg/day of the drug or to increase their dose to between 250 and 400 mg/day for an additional 12 weeks.

For the 30 patients assigned to receive the high dose of sertraline, there was a significant improvement in symptoms that was greater than that seen in the 36 patients taking the low dose.

Total scores on the Yale-Brown Obsessive Compulsive Scale (YBOCS) after 12 weeks were about 22 points for patients taking 200 mg/day of sertraline and 19 points for those taking 250–400 mg/day of the drug.

The average reduction in scores on the National Institute of Mental Health Global Obsessive Compulsive (NIMH Global OC) Scale after 12 weeks was around 1.5 points for patients taking low-dose sertraline, compared with 1.9 for those taking the high dose.

Moreover, the improvement in symptoms was more rapid for those taking 250–400 mg/day of sertraline than for those taking 200 mg/day of the drug.

There was no significant difference in the final response rates, however, at 40% and 33% for those taking 250–400 mg/day and 200 mg/day of sertraline, respectively.

Importantly, the higher doses of sertraline were generally well-tolerated and produced similar rates of adverse events to those in patients taking the 200 mg/day dose, although rates of tremor and agitation were slightly higher with the high doses.

"A high dose of sertraline in nonresponders to 16 weeks of treatment resulted in greater and faster improvement in OCD symptoms," Ninan and team write in the Journal of Clinical Psychiatry.

"Further study of high-dose (and other) treatment strategies for patients with OCD who fail to respond to standard acute treatment is indicated."


Source: J Clin Psychiatry 2006; 67: 15–22

Thank you for this questionaire, I will certainly be using this next visit to the dr