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High-dose escitalopram for the treatment of obsessivecompulsive disorder

Rabinowitz, Ilana; Baruch, Yehudab; Barak, Yoramb

International Clinical Psychopharmacology:
doi: 10.1097/YIC.0b013e3282f0f0c5
Original Articles

The aim of this study was to evaluate the efficacy and tolerability of high-dose escitalopram in patients suffering from obsessive–compulsive disorder (OCD). In an open-label, 16-week prospective study, patients with OCD received escitalopram at a dose of 20 mg/day for 3 weeks, after a 1-week titration at 10 mg/day. Patients who did not achieve a ≥25% reduction from baseline in the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) score during these 4 weeks were continued on higher doses of escitalopram (maximum 50 mg/day) for 12 weeks. The primary efficacy measure of OCD symptoms was change from baseline in the Y-BOCS score. Overall, 67 patients (33 women, 34 men) with a mean Y-BOCS score of 29.6 entered the study. After 4 weeks of standard-dose escitalopram treatment, one patient discontinued owing to pregnancy, and two patients achieved a reduction in Y-BOCS ≥25%. Consequently, 64 patients were eligible to receive high-dose escitalopram (mean dose, 33.8 mg/day at endpoint). At endpoint, high-dose escitalopram had significantly improved the OCD symptoms (Y-BOCS score) and all the other efficacy measures (P<0.001), compared with baseline. Escitalopram was also well tolerated, with no discontinuations during the 12-week high-dose phase. The only reported adverse drug reactions were dry mouth (n=8, 12.1%) and decreased sexual desire (n=21, 31.8%). Preliminary investigation shows that high-dose escitalopram is an efficacious and well tolerated treatment for patients suffering from severe OCD. Randomized, blinded studies are needed to reinforce these findings.

Author Information

aThe YOTAM Treatment Center, Ramat-Gan

bAbarbanel Mental Health Center, Bat-Yam, Israel

Correspondence to Dr Yoram Barak, MD, MHA, Director, Psychogeriatric Department, Abarbanel Mental Health Center, 15 KKL Street, Bat-Yam, Israel

Tel/fax: +972 3 5552738; e-mail:

Abarbanel Mental Health Center is affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel. identifier: NCT00305500

Received 1 March 2007 Accepted 9 August 2007

© 2008 Lippincott Williams & Wilkins, Inc.