Piccinelli M, Pini S, Bellantuono C, Wilkinson G
Servizio di Psicologia Medica, Università di Verona, Italy.
Br J Psychiatry. 1995 Apr;166(4):424-43. doi: 10.1192/bjp.166.4.424.
A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-analytic approach.
Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica-Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms.
Clomipramine was superior to placebo in reducing both obsessive-compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties.
Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive-compulsive symptoms.
采用荟萃分析方法回顾抗抑郁药物治疗强迫症（OCD）患者的疗效。
选取1975年至1994年5月间在同行评审期刊上发表的、针对强迫症患者进行的抗抑郁药物随机双盲临床试验，以及三项即将发表的研究。通过检索医学索引数据库（Medline）和医学文摘 - 精神病学数据库、浏览精神病学和精神药理学期刊、查阅近期发表的综述和文献目录、联系制药公司并通过交叉引用等方式，共找到47项试验。在双盲条件下治疗结束时或该治疗期间最新报告的时间点，对汇总数据计算赫奇斯g值。对于每项试验，针对以下因变量的所有可用结局指标计算效应量：综合考虑的强迫症状；强迫观念；强迫行为；抑郁；焦虑；整体临床改善情况；社会心理适应；以及躯体症状。
氯米帕明在减轻综合考虑的强迫症状（g = 1.31；95%可信区间 = 1.15至1.47）以及单独考虑的强迫观念（g = 0.89，95%可信区间 = 0.36至1.42）和强迫行为（g = 0.79；95%可信区间 = 0.34至1.24）方面均优于安慰剂。此外，作为一类药物，选择性5-羟色胺再摄取抑制剂（SSRIs）也优于安慰剂，综合考虑的强迫症状、单独考虑的强迫观念和强迫行为的加权平均g值分别为0.47（95%可信区间 = 0.33至0.61）、0.54（95%可信区间 = 0.34至0.74）和0.52（95%可信区间 = 0.34至0.70）。尽管在耶鲁布朗强迫症量表（Y-BOCS）上，氯米帕明、氟西汀、氟伏沙明和舍曲林相对于安慰剂的改善率分别提高了61.3%、28.5%、28.2%和21.6%，但比较氯米帕明与氟西汀和氟伏沙明的试验显示，这些药物之间具有相似的治疗效果。最后，氯米帕明和氟伏沙明均被证明优于无选择性5-羟色胺能特性的抗抑郁药物。
抗抑郁药物在强迫症患者的短期治疗中有效；尽管氯米帕明相对于SSRIs在改善率上比安慰剂提高得更多，但这些药物之间的直接比较表明，它们在强迫症状方面具有相似的治疗效果；氯米帕明和氟伏沙明比无选择性5-羟色胺能特性的抗抑郁药物具有更大的治疗效果；对于氯米帕明和SSRIs来说，一开始伴有高水平的抑郁似乎并非改善强迫症状所必需。
