Am J Psychiatry 1997; 154:1261-1264
Copyright © 1997 by American Psychiatric Association
Placebo-controlled trial of fluoxetine and phenelzine for obsessive- compulsive disorder
MA Jenike, L Baer, WE Minichiello, SL Rauch and ML Buttolph
Department of Psychiatry, Massachusetts General Hospital, Charlestown 02129, USA. jenike@psych.mgh.harvard.edu
OBJECTIVE: It is now well documented that fluoxetine is a viable treatment
option for patients with obsessive-compulsive disorder (OCD), and there is
a small body of evidence indicating that monoamine oxidase inhibitors may
be effective in at least a subset of patients. The authors conducted a
10-week placebo-controlled trial of these two agents in patients who met
DSM-III-R criteria for OCD. METHOD: Sixty- four subjects were randomly
assigned to receive placebo, phenelzine (60 mg/day), or fluoxetine (80
mg/day). These doses were achieved by the end of week 3 of the active phase
of the study. Outcomes were assessed with standardized instruments to
measure OCD, mood, and anxiety. RESULTS: Fifty-four patients completed the
study. There was a significant difference among the three treatments on one
OCD scale, with fluoxetine-treated patients improving significantly more
than those in the placebo or phenelzine group. A subgroup of OCD patients
with symmetry obsessions did respond to phenelzine. CONCLUSIONS: This study
provides no evidence to support the use of phenelzine in OCD except
possibly for those patients with symmetry or other atypical obsessions.
There was also no support for the hypothesis that patients with high levels
of anxiety would respond preferentially to phenelzine.
