ABSTRACT
INTRODUCTION: Obsessive-compulsive disorder (OCD) is marked by a high rate of treatment resistance. Patients are often left trialing medications within multiple drug classes with little response, causing heterogeneity to emerge in prescribing patterns. This analysis seeks to investigate the selection and dosing of the pharmacotherapy utilized, to portray an overview of prescribing trends in the United States. METHODS: This retrospective, single center, review of electronic medical records investigated the pharmacotherapy utilization of patients with a primary diagnosis of OCD. Two hundred and ninety-five patients who received OCD treatment at an urban, academic medical center were included in the study. Patients were included in the review if they were at least eighteen years of age and were assigned a diagnosis of OCD according to DSM-5 criteria. RESULTS: Psychotropic pharmacotherapy was integrated into the care of 93% of patients. Selective serotonin reuptake inhibitors were the most utilized medication class at 85% followed by benzodiazepines (47%) and second-generation antipsychotics (37%). Tricyclic antidepressants and first-generation antipsychotics were the two medication classes utilized the least at 13% and 2% respectively. Additionally, mood stabilizers and serotonin-norepinephrine reuptake inhibitors were utilized at rates of 8% and 16%, respectively. CONCLUSIONS: Evidence-based treatment guidelines are being followed with varying augmentation strategies widely prevalent, thus displaying the heterogeneity in treating OCD. A high rate of benzodiazepine utilization highlights a practice trend with potential ties to clinical factors, such as the latency to treatment effect of other first-line pharmacotherapies. Future prospective studies are required to determine the cultural, pharmacoeconomic and pharmacogenomic factors that contribute to the variation in prescribing practices and whether these variations influence treatment outcomes.
ABSTRACT
OBJECTIVE: To examine the evidence for the use of fluoxetine in treatment of underweight and weight-restored patients with anorexia nervosa (AN) and provide recommendations for the clinical usefulness of fluoxetine in AN. DATA SOURCES: Literature was accessed via PubMed through June 2013 using the terms fluoxetine and anorexia nervosa. In addition, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled trials published in English identified from the data sources were evaluated. Studies including the use of fluoxetine in underweight or weight-restored patients with AN were included. Studies of fluoxetine in preclinical animal models of anorexia nervosa were excluded. DATA SYNTHESIS: AN is a serious psychiatric illness with no currently approved medication therapy. Because patients with AN frequently display symptoms of major depressive and obsessive-compulsive disorders, medication therapy is commonly used in attempts to improve these symptoms and prevent relapses of AN. Antidepressants such as fluoxetine are the most frequently used medications for these symptoms. The evidence for fluoxetine in the treatment of AN is controversial, particularly in patients who remain underweight. One theory of inefficacy is that underweight patients do not have the nutrients required to make serotonin, therefore preventing selective serotonin reuptake inhibitors from taking effect. Another theory involves dysregulation of the serotonin receptor. Despite the lack of evidence, fluoxetine may still be useful in certain underweight and weight-restored patients. CONCLUSIONS: The risk-benefit ratio of fluoxetine in underweight and weight-restored patients with AN is undefined by clinical trials; therefore, clinical experience must be applied for its use in this patient population.
