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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by ed_uk on July 23, 2005, at 14:41:37
Has anyone tried Remeron for OCD? Any effect?
Mirtazapine alone...........
J Clin Psychiatry. 2005 Apr;66(4):515-20.
Mirtazapine for obsessive-compulsive disorder: an open trial followed by double-blind discontinuation.
Koran LM, Gamel NN, Choung HW, Smith EH, Aboujaoude EN.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. lkoran@stanford.edu
BACKGROUND: Many patients with obsessive-compulsive disorder (OCD) experience little response to standard treatment with serotonin reuptake inhibitors. Mirtazapine enhances serotonergic function by a mechanism distinct from reuptake inhibition. Because a pilot study suggested effectiveness of mirtazapine in OCD, we conducted a controlled trial. METHOD: We recruited 30 subjects, 15 treatmentnaive and 15 treatment-experienced, with DSM-IV OCD of > or =1 year's duration and a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of > or =20. In the 12-week, open-label phase, subjects received mirtazapine starting at 30 mg/day and titrated over 2 weeks as tolerated to 60 mg/day. At week 12, responders (YBOCS score decrease > 25%) were randomly assigned, double-blind, to continue mirtazapine or switch to placebo for 8 weeks, including a 1-week, double-blind taper week for placebo subjects. RESULTS: In the open-label phase, the mean +/-SD YBOCS score fell from 28.3 +/-3.7 to 20.3 +/-8.5 (paired samples t = 4.81, p < .0001). Four subjects (13.3%) discontinued for side effects. Sixteen subjects (53.3%) (8 treatmentnaive, 8 treatment-experienced) were responders and 15 agreed to randomization. Response was independent of comorbid mood disorders. In the 8-week, double-blind, placebo-controlled discontinuation phase, the mirtazapine group's mean YBOCS score fell a mean +/-SD of 2.6 +/-8.7 points while the placebo group's mean score rose a mean +/-SD of 9.1 +/-7.5 points (Mann Whitney U = 6.5, p = .005, 1-tailed). All other outcome measures were consistent with mirtazapine's superiority versus placebo. CONCLUSION: Mirtazapine may be an effective pharmacotherapy for OCD. If our results are replicated, larger double-blind studies would be indicated.
Mirtazapine + SSRI.............
J Clin Psychiatry. 2004 Oct;65(10):1394-9.
Comment in:
Evid Based Ment Health. 2005 May;8(2):42.
Response acceleration with mirtazapine augmentation of citalopram in obsessive-compulsive disorder patients without comorbid depression: a pilot study.Pallanti S, Quercioli L, Bruscoli M.
Institute for Neurosciences, Florence, Italy. s.pallanti@agora.stm.it
BACKGROUND: Therapeutic action of selective serotonin reuptake inhibitors (SSRIs) is delayed from 8 to 12 weeks in patients with obsessive-compulsive disorder (OCD). Several different agents have been tested to reduce the SSRI therapeutic latency time. Mirtazapine, an antagonist at alpha2-adrenoceptors, does not enhance serotonin (5-HT) neurotransmission directly but disinhibits the norepinephrine activation of 5-HT neurons and thereby increases 5-HT neurotransmission by a mechanism that may not require a time-dependent desensitization of receptors. The present study was undertaken to determine whether the mirtazapine-citalopram combination could induce an earlier and/or greater effect on the 5-HT system in OCD subjects than citalopram alone. METHOD: Forty-nine patients with OCD (DSM-IV) without comorbid depression were randomly assigned to a 2-tailed, single-blind, 12-week clinical trial with citalopram (20-80 mg/day) plus placebo or citalopram plus mirtazapine (15-30 mg/day). Assessments were performed weekly with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Hamilton Rating Scale for Depression, and the Clinical Global Impressions scale. Data were collected from November 2001 to July 2003. RESULTS: The citalopram plus mirtazapine group achieved a reduction of at least 35% in YBOCS score and a "much improved" or "very much improved" rating on the Clinical Global Impressions-Improvement scale from the fourth week, while the citalopram plus placebo group obtained these results only from the eighth week. The number of responders was higher in the citalopram plus mirtazapine group at the fourth week of treatment, while no difference between groups in the response rate was noted at the eighth and twelfth weeks of treatment. CONCLUSIONS: We found an earlier onset of response action in OCD symptoms and reduced undesired side effects when mirtazapine was added to citalopram. This augmentation strategy deserves clinical and research consideration through further double-blind, placebo-controlled studies.
Evid Based Ment Health. 2005 May;8(2):42.
Comment on:
J Clin Psychiatry. 2004 Oct;65(10):1394-9.Mirtazapine plus citalopram has short term but not longer term benefits over citalopram alone for the symptoms of obsessive compulsive disorder.
Schule C, Laakmann G.
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
Publication Types:
Comment~Ed
Posted by linkadge on July 23, 2005, at 15:07:08
In reply to Remeron for OCD, posted by ed_uk on July 23, 2005, at 14:41:37
I would have never seen that coming. Blocks the 2a/c receptors which I thought was a no-no for OCD, and increases frontal noradrenergic and dopaminergic activities.
Don't really have OCD per se, but remeron made it difficult for me to leg go of things.
Linkadge
Posted by ed_uk on July 23, 2005, at 16:48:46
In reply to Re: Remeron for OCD, posted by linkadge on July 23, 2005, at 15:07:08
Hi Link,
I was under the impression that 2c antagonism would be helpful for OCD. m-CPP, a 2c agonist, is thought to worsen OCD.
Atypical APs can also help OCD.........although they can also make it worse in rare cases. Perhaps 5-HT2 antagonism is helpful for most people with OCD but harmful for a few?
~Ed
Posted by linkadge on July 23, 2005, at 17:49:55
In reply to Re: Remeron for OCD » linkadge, posted by ed_uk on July 23, 2005, at 16:48:46
I was under the impression that neuroleptic augmentation of SSRI's was thought to work through d2 antagonism after case reports found that haldol showed clear augmentation of clomipramine in OCD.
The only reason I wonder about the 2a/c receptors is because that blocade of these receptors further increase dopamine output in the frontal cortex, which is generally hyperdopaminergic in OCD.
Surprisingly, there is sufficant evidence that the hallucinogen psilocybin 2a/c agonist posesses significant antiobsessive action.http://www.maps.org/research/psilo/azproto.html
5-ht2c agonism might be ralavant to sexual obsessions, since agonism of the 5-ht2c recpetor decrease dopamine in the NAA, and generally reduces sexual behavior.
http://www.szote.u-szeged.hu/psych/abir1.htmlChou-Green JM, Holscher TD, Dallman MF, Akana SF. Compulsive behavior in the 5-HT2C receptor knockout mouse. Physiol Behav 2003; 78: 641-649.
Does periactin have any effect on our OCD? It made me afraid of microwaves again.Linkadge
Posted by ed_uk on July 23, 2005, at 18:08:54
In reply to Re: Remeron for OCD, posted by linkadge on July 23, 2005, at 17:49:55
Hi Link,
>Does periactin have any effect on our OCD?
I don't think it's been researched in OCD :-(
I thought you found it helpful for anxiety?
~Ed
PS. Have you ever taken a hallucinogen?
Posted by linkadge on July 23, 2005, at 18:38:27
In reply to Re: Remeron for OCD » linkadge, posted by ed_uk on July 23, 2005, at 18:08:54
Periactin was very helpful for physical anxiety, but it did worsen some aspects of mental anxiety.
After periactin I started to panic about going to hell.
Linkadge
Posted by linkadge on July 23, 2005, at 18:40:47
In reply to Re: Remeron for OCD, posted by linkadge on July 23, 2005, at 18:38:27
No, I have never taken a psychadellic. I've only smoked marajuanna once, which was psychoactive, but didn't really notice anything psycadellic.
The only psychadellic experience I had was when I was taking periactin alone for a period of time, and then I dropped it cold turkey and started celexa. I had a whole series of funky visual experiences.
Posted by ace on July 24, 2005, at 0:24:00
In reply to Remeron for OCD, posted by ed_uk on July 23, 2005, at 14:41:37
> Has anyone tried Remeron for OCD? Any effect?
No help for OCD, but helped depression significantly. Eventually had to stop due to it inducing night-time vomiting on a regular basis. Oh, this drug makes you eat a lot too!
Ace>
> Mirtazapine alone...........
>
> J Clin Psychiatry. 2005 Apr;66(4):515-20.
>
> Mirtazapine for obsessive-compulsive disorder: an open trial followed by double-blind discontinuation.
>
> Koran LM, Gamel NN, Choung HW, Smith EH, Aboujaoude EN.
>
> Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. lkoran@stanford.edu
>
> BACKGROUND: Many patients with obsessive-compulsive disorder (OCD) experience little response to standard treatment with serotonin reuptake inhibitors. Mirtazapine enhances serotonergic function by a mechanism distinct from reuptake inhibition. Because a pilot study suggested effectiveness of mirtazapine in OCD, we conducted a controlled trial. METHOD: We recruited 30 subjects, 15 treatmentnaive and 15 treatment-experienced, with DSM-IV OCD of > or =1 year's duration and a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of > or =20. In the 12-week, open-label phase, subjects received mirtazapine starting at 30 mg/day and titrated over 2 weeks as tolerated to 60 mg/day. At week 12, responders (YBOCS score decrease > 25%) were randomly assigned, double-blind, to continue mirtazapine or switch to placebo for 8 weeks, including a 1-week, double-blind taper week for placebo subjects. RESULTS: In the open-label phase, the mean +/-SD YBOCS score fell from 28.3 +/-3.7 to 20.3 +/-8.5 (paired samples t = 4.81, p < .0001). Four subjects (13.3%) discontinued for side effects. Sixteen subjects (53.3%) (8 treatmentnaive, 8 treatment-experienced) were responders and 15 agreed to randomization. Response was independent of comorbid mood disorders. In the 8-week, double-blind, placebo-controlled discontinuation phase, the mirtazapine group's mean YBOCS score fell a mean +/-SD of 2.6 +/-8.7 points while the placebo group's mean score rose a mean +/-SD of 9.1 +/-7.5 points (Mann Whitney U = 6.5, p = .005, 1-tailed). All other outcome measures were consistent with mirtazapine's superiority versus placebo. CONCLUSION: Mirtazapine may be an effective pharmacotherapy for OCD. If our results are replicated, larger double-blind studies would be indicated.
>
> Mirtazapine + SSRI.............
>
> J Clin Psychiatry. 2004 Oct;65(10):1394-9.
>
> Comment in:
> Evid Based Ment Health. 2005 May;8(2):42.
>
> Response acceleration with mirtazapine augmentation of citalopram in obsessive-compulsive disorder patients without comorbid depression: a pilot study.
>
> Pallanti S, Quercioli L, Bruscoli M.
>
> Institute for Neurosciences, Florence, Italy. s.pallanti@agora.stm.it
>
> BACKGROUND: Therapeutic action of selective serotonin reuptake inhibitors (SSRIs) is delayed from 8 to 12 weeks in patients with obsessive-compulsive disorder (OCD). Several different agents have been tested to reduce the SSRI therapeutic latency time. Mirtazapine, an antagonist at alpha2-adrenoceptors, does not enhance serotonin (5-HT) neurotransmission directly but disinhibits the norepinephrine activation of 5-HT neurons and thereby increases 5-HT neurotransmission by a mechanism that may not require a time-dependent desensitization of receptors. The present study was undertaken to determine whether the mirtazapine-citalopram combination could induce an earlier and/or greater effect on the 5-HT system in OCD subjects than citalopram alone. METHOD: Forty-nine patients with OCD (DSM-IV) without comorbid depression were randomly assigned to a 2-tailed, single-blind, 12-week clinical trial with citalopram (20-80 mg/day) plus placebo or citalopram plus mirtazapine (15-30 mg/day). Assessments were performed weekly with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Hamilton Rating Scale for Depression, and the Clinical Global Impressions scale. Data were collected from November 2001 to July 2003. RESULTS: The citalopram plus mirtazapine group achieved a reduction of at least 35% in YBOCS score and a "much improved" or "very much improved" rating on the Clinical Global Impressions-Improvement scale from the fourth week, while the citalopram plus placebo group obtained these results only from the eighth week. The number of responders was higher in the citalopram plus mirtazapine group at the fourth week of treatment, while no difference between groups in the response rate was noted at the eighth and twelfth weeks of treatment. CONCLUSIONS: We found an earlier onset of response action in OCD symptoms and reduced undesired side effects when mirtazapine was added to citalopram. This augmentation strategy deserves clinical and research consideration through further double-blind, placebo-controlled studies.
>
> Evid Based Ment Health. 2005 May;8(2):42.
>
> Comment on:
> J Clin Psychiatry. 2004 Oct;65(10):1394-9.
>
> Mirtazapine plus citalopram has short term but not longer term benefits over citalopram alone for the symptoms of obsessive compulsive disorder.
>
> Schule C, Laakmann G.
>
> Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
>
> Publication Types:
> Comment
>
> ~Ed
Posted by ed_uk on July 24, 2005, at 4:41:39
In reply to Re: Remeron for OCD, posted by linkadge on July 23, 2005, at 18:38:27
Hi Link,
ACE said....
Pericatin precipitated a 5 hour extreme relapse into oCD, panic, derealization...
He finds atypical APs helpful though.
~Ed
Posted by linkadge on July 24, 2005, at 5:26:51
In reply to Re: Remeron for OCD » linkadge, posted by ed_uk on July 24, 2005, at 4:41:39
hmmm.
Linkadge
This is the end of the thread.
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