CONCLUSIONS The effects of treatment with clomipramine and selective serotonin reuptake inhibitors ( SSRIs : fluvoxamine , sertraline , fluoxetine , citalopram , and escitalopram ) proved to be similar , except for the lower adherence rate in case of clomipramine because of its side effects .
PURPOSE This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder ( OCD ) , addressing two major issues : which treatment is most effective in treating the patient 's symptoms and which is beneficial for maintaining remission .
A double-blind comparison of sertraline and clomipramine in outpatients with obsessive-compulsive disorder.
The aim of this study was to compare the efficacy , safety , and tolerability of sertraline and clomipramine in the treatment of obsessive-compulsive disorder ( OCD ) . Out patients with DSM-III-R defined OCD for 1 year or longer and scores of > /=20 on the YaleBrown Obsessive Compulsive Scale ( Y-BOCS ) , > /=7 on the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH-OC ) , > /=4 on the Clinical Global Impression Severity of Illness Scale ( CGI-S ) and < /=17 on the Hamilton Depression Scale ( 17 item HAMD ) were r and omized to sertraline  ( n = 86 ) or  clomipramine  ( n = 82 ) once daily for 16 weeks . Initial daily doses of sertraline and clomipramine were 50 mg . After a minimum of 4 weeks , these doses could be increased by 50 mg increments every 2 weeks to a maximum of 200 mg daily if the response was thought inadequate . Efficacy was assessed at the end of 1 , 2 , 4 , 6 , 8 , 12 and 16 weeks of therapy using the Y-BOCS , NIMH-OC , CGI-S , CGI Improvement Scale ( CGI-I ) and Clinical Anxiety Scale ( CAS ) .  One hundred sixty-eight patients were r and omized and received at least one dose of double-blind medication ; 86 received sertraline and 82 clomipramine . Mean final daily doses at final visit were clomipramine 90 mg ( efficacy evaluable patients 101 mg , completers 110 mg ) , and sertraline 129 mg ( efficacy evaluable patients 132 mg , completers 136 mg ) . Mean baseline Y-BOCS , NIMH-OC and CGI-S totals were 27.7 , 10.1 and 5.5 , respectively , for sertraline and 27.4 , 9.9 and 5.5 , respectively , for clomipramine . Sertraline demonstrated greater efficacy than clomipramine in the intent-to-treat patient group : mean baseline to final visit changes were 50.8 % ( Y-BOCS ) , 41.9 % ( NIMH-OC ) and 37.7 % ( CGI-S ) for sertraline and 42.9 % ( Y-BOCS ) , 33.8 % ( NIMH-OC ) and 30.0 % ( CGI-S ) for clomipramine ( P < 0.05 ) . The number of patients withdrawing because of adverse events was substantially greater for clomipramine ( 26 % ) than sertraline ( 11 % ) ( P < 0.05 ) . The most frequent adverse events for clomipramine were dry mouth ( 20 % ) , anxiety ( 17 % ) , constipation ( 16 % ) , nausea ( 15 % ) and somnolence ( 11 % ) , and for sertraline , diarrhea ( 12 % ) and nausea ( 12 % ) . In this study , sertraline was more effective than clomipramine in the intent-to-treat analysis . The difference in efficacy between the treatments is almost wholly accounted for by a greater number of clomipramine withdrawals due to the poor patient acceptance of clomipramine . The superior tolerability of sertraline and the lower rate of premature treatment withdrawal relative to clomipramine may offer considerable quality of life and compliance benefits in the long-term management of a chronic disorder such as OCD
CONCLUSIONS The effects of treatment with clomipramine and selective serotonin reuptake inhibitors ( SSRIs : fluvoxamine , sertraline , fluoxetine , citalopram , and escitalopram ) proved to be similar , except for the lower adherence rate in case of clomipramine because of its side effects .
PURPOSE This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder ( OCD ) , addressing two major issues : which treatment is most effective in treating the patient 's symptoms and which is beneficial for maintaining remission .