Longitudinal course of pharmacotherapy in obsessive–compulsive disorder
Open accessAbstract
BACKGROUND: Although data fully support the use of serotonin reuptake inhibitors (SRIs) in the treatment of obsessive-compulsive disorder (OCD), investigations on pharmacotherapy discontinuation during the course of OCD are lacking. This 5-year prospective study sought to better understand the long-term course of SRI utilization among individuals with OCD. METHODS: A total of 252 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. OCD, treated with medication in the community, were examined for discontinuation and resumption of SRIs. Data on weekly OCD symptoms, medications, and dosage changes were obtained annually using the Longitudinal Interval Follow-up Evaluation. RESULTS: During the 5-year follow-up period, 151 patients had at least one trial of an SRI for 12 weeks or more. A total of 110 patients (43.7%) discontinued their medication (i.e. ceased taking medication for ≥4 weeks) at least once during the follow-up period. In patients symptomatic at the time of discontinuation, the cumulative incidence of worsening of OCD after SRI discontinuation was 9.8%, whereas in patients in partial or full remission at the time of discontinuation, the corresponding cumulative incidence was 33.3%. Among patients with worsening of OCD upon SRI discontinuation, the median time to worsening was 39 weeks. CONCLUSION: This first longitudinal study on the use of SRIs in OCD found that patients who had achieved partial or full remission on SRIs were less likely to discontinue medication, and the cumulative incidence of worsening of OCD after discontinuation was negatively associated with OCD severity at the time of SRI discontinuation.
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Standard-of-care treatments for OCD continue to be limited by low remission and high relapse rates.
“they continue to be limited by low remission (12–16) and high relapse rates (17, 18)”
From Acute and post-dosing effects of single-dose psilocybin for obsessive-compulsive disorder in a randomized, double-blind, placebo-controlled trial: an interpretative phenomenological analysis (2025) · cites this paper as [17]
The citation is attached to the claim of high relapse rates. The Discussion (page unavailable) instead says that patients in partial or full remission who discontinued SRIs had a 33.3% cumulative incidence of symptom worsening and that discontinuation was generally not associated with significant worsening. This naturalistic finding does not support the attributed claim of high relapse rates. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredBaseline obsessive-compulsive disorder symptom level is likely a prognostic factor affecting severity and discontinuation outcomes.
“Level of OCD symptomatology at baseline (pre-intervention) is likely a prognostic factor affecting severity and discontinuation outcomes [7] and therefore is controlled during randomization.”
From Unified protocol for the discontinuation of long-term serotonin reuptake inhibitors in obsessive compulsive disorder: Study protocol and methods (2018) · cites this paper as [7]
The Results sections on SRI discontinuation and the course after discontinuation link OCD symptom status to stopping medication and symptom severity at discontinuation to subsequent worsening. They do not establish that symptom level at baseline, before an intervention, predicts those outcomes; this was a naturalistic study rather than a randomized intervention. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNaturalistic observations suggest that most obsessive-compulsive disorder patients stop maintenance serotonin reuptake inhibitors without significant symptom worsening.
“These findings, however, are inconsistent with naturalistic observations suggesting that the majority of OCD patients discontinue maintenance SRIs without significant symptom worsening [7].”
From Unified protocol for the discontinuation of long-term serotonin reuptake inhibitors in obsessive compulsive disorder: Study protocol and methods (2018) · cites this paper as [7]
The Discussion reports that SRI discontinuation was generally not associated with significant symptom worsening; among patients in partial or full remission who stopped, the cumulative incidence of worsening was 33.3%. But the Results (Discontinuation of serotonin reuptake inhibitors) show that only 43.7% of SRI-treated adults discontinued at least once, so the paper does not support saying that a majority of patients stopped treatment. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSerotonin reuptake inhibitors are the most frequently prescribed medications for obsessive-compulsive disorder, and lifetime use exceeds 90% in treatment-seeking samples.
“Serotonin reuptake inhibitors (SRIs) are the most commonly prescribed medications for OCD [5] with large observational studies estimating lifetime utilization at over 90% in treatment-seeking populations [6,7].”
From Unified protocol for the discontinuation of long-term serotonin reuptake inhibitors in obsessive compulsive disorder: Study protocol and methods (2018) · cites this paper as [7]
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Research works printed but not linked: 5
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- Goodman WK Price LH Rasmussen SA Mazure C Fleischmann RL Hill CL The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability Arch Gen Psychiatry 1989a 46 1006 1011 2684084
- Keller MB Lavori PW Friedman B Nielsen E Endicott J McDonald-Scott P Andreasen NC The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies Arch Gen Psychiatry 1987 44 540 548 3579500
- Mancebo MC Eisen JL Pinto A Greenberg BD Dyck IR Rasmussen SA The brown longitudinal obsessive compulsive study: treatments received and patient impressions of improvement J Clin Psychiatry 2006 67 1713 1720 17196050
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Obsessive-Compulsive and Related Disorders
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Self-citationBoisseau, C. L., & Rasmussen, S. A. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2017.12.017
“Serotonin reuptake inhibitors (SRIs) are the most commonly prescribed medications for OCD [5] with large observational studies estimating lifetime utilization at over 90% in treatment-seeking populations [6,7].”
BackgroundResultSelf-citationObsessive–Compulsive and Related Disorders: Obsessive–Compulsive Disorder and Hoarding Disorder
Pato, M. T., Steketee, G. S., Eisen, J. L., Yip, A. G., & Phillips, K. A. (2015) · Wiley eBooks · doi:10.1002/9781118753378.ch57
Self-citationPato, M. T., Arnold, P. D., Zohar, J., Bitan, S., Klein, K. P., & Eisen, J. L. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_23
Self-citation
- Authors
- Grant, J. E., Mancebo, M. C., Weinhandl, E., Odlaug, B. L., Eisen, J. L., & Rasmussen, S. A.
- Affiliations
- University of Chicago (US)
- Brown University (US)
- University of Copenhagen (DK)
- Venue
- International Clinical Psychopharmacology
- Published
- 2013-04
- Volume
- 28
- Issue
- 4
- Pages
- 1
- ISSN
- 0268-1315 (ISSN-L)
- PMC
- PMC3920831
- OpenAlex
- W2079984335
- Cited by
- 12
- References
- 0
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2018: 2 · 2017: 1 · 2015: 2 · 2013: 1
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- International Clinical Psychopharmacology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- National Center for Responsible Gaming
- H. Lundbeck A/S
- National Institutes of Health (5rc1da028279-02)
- National Institute of Mental Health (R01MH0602018, R01MH060218, K23MH091032)
- National Institute on Drug Abuse (RC1-DA028279, 1RC1DA 028279-01)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, serotonin reuptake inhibitors, remission, OCD severity, outpatient care
- MeSH terms
- Adult, Ambulatory Care, Community Mental Health Centers, Female, Humans, Longitudinal Studies, Male, Middle Aged, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Remission Induction, Drug Monitoring, Selective Serotonin Reuptake Inhibitors, Diagnostic and Statistical Manual of Mental Disorders, Secondary Prevention, Young Adult
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