Effectiveness of Venlafaxine in Selective Serotonin Reuptake Inhibitor-Resistant Obsessive-Compulsive Disorder: Experience From a Specialty Clinic in India.

BACKGROUND: Despite its favorable pharmacological profile and efficacy in major depression and anxiety disorders, evidence for the use of venlafaxine in obsessive-compulsive disorder (OCD) is limited. We sought to examine the real-world effectiveness of venlafaxine from a large database of an OCD clinic in India. METHODS: A total of 1704 consecutive patients who registered at the OCD clinic between June 2014 and December 2016 were evaluated with structured interviews and scales. Patients with symptomatic OCD (Yale-Brown Obsessive-Compulsive Severity ≥16) despite treatment with selective serotonin reuptake inhibitors and initiated on venlafaxine were included for analysis. The main outcome measures were response as defined by 35% or more reduction in the Yale-Brown Obsessive-Compulsive Severity total score and "all-cause discontinuation." RESULTS: Of a total of 65 patients who were eligible for analysis, 29(45%) were responders at the end of 16 weeks and 27 (42%) continued to remain on venlafaxine. Repeated measures analysis of variance yielded significant reduction in the Yale-Brown Obsessive-Compulsive Severity total score (F(1.29, 82.4) = 56.54, P < 0.001, partial η = 0.469). On regression analysis, only lower insight (P = 0.048) predicted poor response. CONCLUSIONS: The study suggests that venlafaxine may be useful in a proportion of patients with poor response to selective serotonin reuptake inhibitors and therefore requires to be studied in controlled trials.

Gray matter volume abnormalities and clinical correlates in OCD with exclusive washing dimension.

OBJECTIVE: Obsessive compulsive disorder (OCD) is increasingly being recognized as a heterogeneous disorder with various symptom dimensions. In order to understand the neurobiology of obsessive-compulsive disorder (OCD), it is important to understand the brain basis of homogeneous symptom groups. In this study we investigated the gray matter (GM) changes and correlates of an exclusively homogenous sample of OCD patients (washers with no other obsessive compulsive symptoms). METHOD: We compared the structural MRI scans (3T) using voxel-based morphometry (VBM) of washers (N = 35) with matched healthy controls (HC) (N = 39). RESULTS: We found volume deficits corresponding to right inferior frontal gyrus, parahippocampal gyrus and right anterior lobe of cerebellum among washers compared to HC. Among the washers, GM volume of right inferior frontal gyrus, right uncus of the limbic lobe, left cuneus and left superior temporal lobe had significant negative correlation with the illness severity score. CONCLUSION: Examining homogenous sub-groups of OCD patients may help us further our understanding of neurobiology of OCD.