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What is the optimal dose of escitalopram for the treatment of obsessive–compulsive disorder? A naturalistic open-label study

Shim, Geumsooka; Park, Hye Youna; Jang, Joon Hwana; Kim, Euitaea; Park, Hye Yoona; Hwang, Jae Yeona,b; Kim, Sung Nyuna; Jang, Go-Eunc; Kwon, Jun Sooa,b,c

International Clinical Psychopharmacology: September 2011 - Volume 26 - Issue 5 - p 284–290
doi: 10.1097/YIC.0b013e32834a5c09
Original Articles

This study explored the efficacy and tolerability of very high doses (maximum dose of >40 mg/day), high doses (maximum dose of 25–40 mg/day), and standard doses (maximum dose of ≤20 mg/day) of escitalopram (ESC) as an anti-obsessive–compulsive disorder treatment in a naturalistic clinical setting. We reviewed the medical records of all patients with obsessive–compulsive disorder (n=246) who had taken ESC between May 2006 and September 2009, and assigned Clinical Global Impression (CGI) scores, retrospectively. Of the total sample, 24.4, 38.2, and 37.4% patients received very high, high, and standard doses of ESC, and the mean daily maximum doses of ESC were 57.3±12.0 mg, 33.9±5.4 mg, and 13.4±5.8 mg, respectively. The CGI-Severity scores in each group decreased significantly after treatment with ESC, as evidenced by response rates (i.e. CGI-Improvement scores of 1 or 2) of 46.3, 43.2, and 26.2%, respectively. Although some adverse events increased in a dose-dependent manner, most could be managed with an ESC dose adjustment. These results imply that doses less than or equal to 40 mg/day ESC are sufficient for symptomatic improvement with good tolerability for most patients. Very high doses of ESC, on the other hand, can be considered for patients with inadequate therapeutic responses to the administration of 40 mg/day ESC.

aDepartment of Psychiatry, Seoul National University, College of Medicine

bBrain and Cognitive Sciences-WCU program, College of Natural Sciences, Seoul National University

cClinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Korea

Correspondence to Professor Jun Soo Kwon, MD, PhD, Department of Psychiatry, Seoul National University, College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, 110–744, Korea Tel: +82 2 2072 2972; fax: +82 2 747 9063; e-mail:

Received March 18, 2011

Accepted June 28, 2011

© 2011 Lippincott Williams & Wilkins, Inc.