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Comparison of Fluvoxamine and Desipramine

Wayne K. Goodman, MD; Lawrence H. Price, MD; Pedro L. Delgado, MD; Joseph Palumbo, MD; John H. Krystal, MD; Linda M. Nagy, MD; Steven A. Rasmussen, MD; George R. Heninger, MD; Dennis S. Charney, MD

Arch Gen Psychiatry. 1990;47(6):577-585.

Abstract
• To evaluate whether serotonin reuptake inhibition is critical to the treatment of obsessive-compulsive disorder, 40 outpatients with a principal diagnosis of obsessive-compulsive disorder were randomized in a double-blind fashion to 8 weeks of treatment with either the serotonin reuptake inhibitor fluvoxamine maleate (n = 21) or the norepinephrine reuptake inhibitor desipramine hydrochloride (n =19). Fluvoxamine was significantly better than desipramine in reducing the severity of obsessive-compulsive symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale and by the global response rate ("responder" equaling "much improved"). Eleven of 21 patients were responders with fluvoxamine compared with 2 of 19 patients with desipramine. Fluvoxamine, but not desipramine, was also effective in reducing the severity of "secondary" depression. Fluvoxamine-induced improvement in symptoms of obsessive-compulsive disorder was not correlated with the severity of baseline depressive symptoms. This study provides additional evidence that the acute serotonin reuptake properties of a drug are predictive of its anti—obsessive-compulsive efficacy. It is hypothesized that the mechanism of action of serotonin reuptake inhibitors in obsessive-compulsive disorder may be related to chronic treatment-induced adaptive changes in presynaptic serotonin receptor function (eg, autoreceptor desensitization) and/ or indirect influences on dopaminergic function (eg, in the basal ganglia).

Author Affiliations
From the Clinical Neuroscience Research Unit, Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, New Haven (Drs Goodman, Price, Delgado, Palumbo, Krystal, Nagy, Heninger, and Charney); and Department of Psychiatry, Butler Hospital, Brown University School of Medicine, Providence, RI (Dr Rasmussen).

Footnotes
Accepted for publication November 21, 1989.

Reprint requests to Department of Psychiatry, Yale University School of Medicine, 34 Park St, New Haven, CT 06508 (Dr Goodman).

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