Rabinowitz Ilan, Baruch Yehuda, Barak Yoram
The YOTAM Treatment Center, Ramat-Gan bAbarbanel Mental Health Center, Bat-Yam, Israel.
Int Clin Psychopharmacol. 2008 Jan;23(1):49-53. doi: 10.1097/YIC.0b013e3282f0f0c5.
The aim of this study was to evaluate the efficacy and tolerability of high-dose escitalopram in patients suffering from obsessive-compulsive disorder (OCD). In an open-label, 16-week prospective study, patients with OCD received escitalopram at a dose of 20 mg/day for 3 weeks, after a 1-week titration at 10 mg/day. Patients who did not achieve a > or =25% reduction from baseline in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score during these 4 weeks were continued on higher doses of escitalopram (maximum 50 mg/day) for 12 weeks. The primary efficacy measure of OCD symptoms was change from baseline in the Y-BOCS score. Overall, 67 patients (33 women, 34 men) with a mean Y-BOCS score of 29.6 entered the study. After 4 weeks of standard-dose escitalopram treatment, one patient discontinued owing to pregnancy, and two patients achieved a reduction in Y-BOCS > or =25%. Consequently, 64 patients were eligible to receive high-dose escitalopram (mean dose, 33.8 mg/day at endpoint). At endpoint, high-dose escitalopram had significantly improved the OCD symptoms (Y-BOCS score) and all the other efficacy measures (P<0.001), compared with baseline. Escitalopram was also well tolerated, with no discontinuations during the 12-week high-dose phase. The only reported adverse drug reactions were dry mouth (n=8, 12.1%) and decreased sexual desire (n=21, 31.8%). Preliminary investigation shows that high-dose escitalopram is an efficacious and well tolerated treatment for patients suffering from severe OCD. Randomized, blinded studies are needed to reinforce these findings.
本研究的目的是评估高剂量艾司西酞普兰治疗强迫症（OCD）患者的疗效和耐受性。在一项开放标签的16周前瞻性研究中，强迫症患者在以10mg/天的剂量进行1周滴定后，接受20mg/天的艾司西酞普兰治疗3周。在这4周内，耶鲁-布朗强迫症量表（Y-BOCS）评分较基线降低未达到≥25%的患者继续接受更高剂量的艾司西酞普兰（最大50mg/天）治疗12周。强迫症症状的主要疗效指标是Y-BOCS评分相对于基线的变化。总体而言，67例平均Y-BOCS评分为29.6的患者（33名女性，34名男性）进入了该研究。在标准剂量的艾司西酞普兰治疗4周后，1例患者因怀孕而停药，2例患者的Y-BOCS评分降低≥25%。因此，64例患者有资格接受高剂量的艾司西酞普兰治疗（终点时平均剂量为33.8mg/天）。在终点时，与基线相比，高剂量的艾司西酞普兰显著改善了强迫症症状（Y-BOCS评分）以及所有其他疗效指标（P<0.001）。艾司西酞普兰的耐受性也良好，在12周的高剂量阶段没有患者停药。唯一报告的药物不良反应是口干（n=8，12.1%）和性欲减退（n=21，31.8%）。初步调查表明，高剂量艾司西酞普兰对重度强迫症患者是一种有效且耐受性良好的治疗方法。需要进行随机、盲法研究来强化这些发现。
