High-dose duloxetine for treatment-resistant obsessive-compulsive disorder: a case report with sustained full remission.

摘要

To the Editor: Obsessive-compulsive disorder (OCD) is classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, with lifetime prevalence of approximately 2percent to 3percent in the general population. It is a chronic and debilitating psychiatric disorder that resulted in time-consuming behaviors, impaired role functioning, and diminished well-being. The biological models of OCD focused on the dysregula-tion of serotonin, whereas few evidences imply the noradrenergic dysfunction in OCD. Based on the hypothesis, selective serotonin reuptake inhibitors (SSRIs) are the first-line strategy in the treatment of OCD, but approximately 40percent to 60percent of patients with OCD fail to respond to them.4 Venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI), was also proven to be useful in OCD treatment, even in SSRI-resistant OCD. It suggests that SNRI has probable superiority in the treatment of refractory OCD. Currently, augmentation of antidepressants with atypical antipsychotics becomes a second-line choice in treatment-resistant OCD. Here, we report a 30-year-old man with severe chronic OCD comorbid with major depression that was refractory to treatment with numerous SSRIs, venlafaxine (one of SNRIs), and atypical antipsychotic augmentation, who responded to 12 weeks of monotherapy of high-dose duloxetine, a newer SNRI, and achieved sustained full remission under maintenance treatment.