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Time to reconsider monoamine oxidase inhibitors for obsessive compulsive disorder?: a case series using phenelzine

Time to reconsider monoamine oxidase inhibitors for obsessive compulsive disorder?: a case series using phenelzine
Time to reconsider monoamine oxidase inhibitors for obsessive compulsive disorder?: a case series using phenelzine

Purpose/Background Despite the availability of a range of efficacious evidence-based treatments for obsessive-compulsive disorder (OCD), not all patients experience sufficient benefit or are able to tolerate them in practice. Monoamine oxidase inhibitors (MAOIs) show efficacy in the treatment of depression and certain anxiety disorders (such as social anxiety disorder). Methods/Procedures We survey the evidence base from case reports, and clinical trials, regarding use of MAOIs in OCD. We then present new data from a case series collected in routine clinical practice in a specialist clinical service. Findings/Results In 9 treatment-resistant patients whose OCD had not improved with at least 2 standard treatment trials, 3 had marked clinical improvement (>35% improvement on YBOCS) on phenelzine, 3 had some improvement (15-34.9%), and 3 showed minimal or no improvement (<15%). In the 3 patients who experienced minimal/no improvement, 2 had discontinued early because of lack of tolerability, and the other patient discontinued after 4 weeks because of perceived lack of symptom benefit. Implications/Conclusions We suggest that (1) MAOIs in treatment-resistant OCD require appropriate research scrutiny in large-scale randomized controlled trials; and (2) MAOIs merit consideration as a treatment option in individual cases of OCD, particularly in specialist settings where first-line interventions have proven inadequate to manage severe symptoms.

MAOI, obsessive compulsive disorder, phenelzine
0271-0749
461-464
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Chamberlain, Samuel
8a0e09e6-f51f-4039-9287-88debe8d8b6f
Grant, Jon E.
15ed8f1b-3f52-4576-b842-1056cf9331b0
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Chamberlain, Samuel
8a0e09e6-f51f-4039-9287-88debe8d8b6f
Grant, Jon E.
15ed8f1b-3f52-4576-b842-1056cf9331b0

Baldwin, David, Chamberlain, Samuel and Grant, Jon E. (2021) Time to reconsider monoamine oxidase inhibitors for obsessive compulsive disorder?: a case series using phenelzine. Journal of Clinical Psychopharmacology, 41 (4), 461-464. (doi:10.1097/JCP.0000000000001418).

Record type: Article

Abstract

Purpose/Background Despite the availability of a range of efficacious evidence-based treatments for obsessive-compulsive disorder (OCD), not all patients experience sufficient benefit or are able to tolerate them in practice. Monoamine oxidase inhibitors (MAOIs) show efficacy in the treatment of depression and certain anxiety disorders (such as social anxiety disorder). Methods/Procedures We survey the evidence base from case reports, and clinical trials, regarding use of MAOIs in OCD. We then present new data from a case series collected in routine clinical practice in a specialist clinical service. Findings/Results In 9 treatment-resistant patients whose OCD had not improved with at least 2 standard treatment trials, 3 had marked clinical improvement (>35% improvement on YBOCS) on phenelzine, 3 had some improvement (15-34.9%), and 3 showed minimal or no improvement (<15%). In the 3 patients who experienced minimal/no improvement, 2 had discontinued early because of lack of tolerability, and the other patient discontinued after 4 weeks because of perceived lack of symptom benefit. Implications/Conclusions We suggest that (1) MAOIs in treatment-resistant OCD require appropriate research scrutiny in large-scale randomized controlled trials; and (2) MAOIs merit consideration as a treatment option in individual cases of OCD, particularly in specialist settings where first-line interventions have proven inadequate to manage severe symptoms.

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OCD-phenelzine-3-27-21 - Accepted Manuscript
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Accepted/In Press date: 2 April 2021
e-pub ahead of print date: 1 July 2021
Published date: 1 July 2021
Keywords: MAOI, obsessive compulsive disorder, phenelzine

Identifiers

Local EPrints ID: 450147
URI: http://eprints.soton.ac.uk/id/eprint/450147
ISSN: 0271-0749
PURE UUID: 1ab682df-d8be-49f3-abcc-795ea81d95f3
ORCID for David Baldwin: ORCID iD orcid.org/0000-0003-3343-0907
ORCID for Samuel Chamberlain: ORCID iD orcid.org/0000-0001-7014-8121

Catalogue record

Date deposited: 14 Jul 2021 16:30
Last modified: 26 Nov 2021 03:22

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Contributors

Author: David Baldwin ORCID iD
Author: Samuel Chamberlain ORCID iD
Author: Jon E. Grant

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