cost-effectiveness of adding web-based cognitive-behavioral therapy (cbt) to luvox cr for obsessive compulsive disorder (ocd)

Conditions: Obsessive Compulsive Disorder

Summary: this study will test the hypotheses that: 1. 12 weeks of luvox-cr plus web-based cognitive-behavioral therapy (cbt) \[ct-steps\] will produce greater symptom relief of ocd than treatment with luvox-cr alone; and, 2. subjects receiving 12 weeks of ct-steps added to luvox-cr treatment after 12-weeks of luvox-cr monotherapy will experience greater ocd symptom relief (from weeks 12-24) than those continuing luvox-cr treatment and having access to ct-steps from week one. 3. subjects who begin ct-steps at week 12 will be more likely to complete it than those who begin ct-steps at baseline.

primary endpoint(s): change in y-bocs score from baseline to endpoint at weeks 12 and 24; and, number (and percent) "responders" at weeks 12 and 24, defined as subjects with a 35% decrease in y-bocs score at endpoint and a clinical global impressions score of 1 or 2 (very much or much improved). secondary endpoint(s): 1. change in scores on the work and social adjustment scale, a quality of life measure 2. change in scores on the work productivity and activity impairment questionnaire: specific health problem scale; in particular, we will analyze change in work hours/week lost because of ocd, and change in effect of ocd on work productivity (0-10 scale). 3. dollar cost per responder 4. dollar cost per total number of patients needed to produce one additional responder in the luvox-cr plus web-based cbt group over the number produced by luvox-cr alone, i.e., dollar cost per number needed to treat 5. dollar cost per 5% decrease in y-bocs score at weeks 12 and 24 in the two treatment groups.

Eligibility criteria:
inclusion criteria: * men and women aged 18 years, with ocd of at least 1 year's duration, meeting dsm-iv diagnostic criteria, and having a baseline yale-brown obsessive-compulsive scale (y-bocs) score of 18. exclusion criteria: * pregnant or nursing women or women of childbearing age not using an effective contraceptive method * organic mental disorder * bipolar disorder * psychotic disorder * history of substance abuse or dependence within 3 years of evaluation for study * major depression with suicidal risk * major depression dominating the clinical picture * panic disorder * personality disorder severe enough to interfere with cooperation with study procedures * need for antipsychotic medication * depot neuroleptic drug within 6 months * fluoxetine within 5 weeks * an maoi within 2 weeks, any nightly sedative, or taking a medication that may interact with fluvoxamine * serious or unstable medical condition (hematological, endocrine, cardiovascular, renal or gastrointestinal), a history of malignancy (other than excised basal cell carcinoma), history of brain disease, including more than one childhood febrile convulsion and all forms of epilepsy; or, are receiving behavior therapy for ocd. * subjects who qualify for the study while taking an ssri must have been taking their current dose or a higher dose for at least 12 weeks prior to study baseline. * subjects who qualify for the study while taking fluvoxamine must be taking no more than 150 mg/day and never had a trial at a higher dose, must be believed by the investigator to be able to tolerate an increase to 250 mg/day starting at baseline, and must have been taking their pre-study dose or a higher dose (up to 150 mg/day) for at least 12 weeks prior to study baseline.