Venlafaxine extended release as a treatment option after SSRI-s nonresponse and intolerance in obsessive-compulsive disorder:Case report

Abstract

Growing body of evidence suggests that serotonin-norepinephrine reuptake inhibitor (SNRI) (venlafaxine) may represent a valid alternative to the serotonin reuptake inhibitors (SSRIs), in a treatment of OCD patients, especially in the cases after SSRIs nonresponse and/or intolerance. Dosing strategies for venlafaxine is important, because, as a data from studies show, in «low» doses venlafaxine acts as a selective 5-HT reuptake inhibitor, whereas in higher doses (225 and 375 mg/d) acts as a dual 5-HT and NE reuptake inhibitor. We report the case of the patient diagnosed of severe OCD (DSM-IV-TR), who failed to respond on two SSRIs treatment trials (fluoxetine and sertraline) and showed a intolerance on one SSRI (fluvoxamine) treatment trial. As a augmentation for all previous SSRIs treatment trials in our case was used dopamine antagonist risperidone (mean dose=2 mg/d).After eight weeks of treatment with venlafaxine extended release, (150 mg/d) and risperidone (2 mg/d) as coadjuvant treatment, the patient had clinically significant improvement (measured by decrease in the score of the Yale-Brown Obsessive Compulsive (Y-BOCS) and the Clinical Global Impression (CGI) scales), with no clinically significant side-effects. Further improvement was subsequently maintained. In treatment- resistant OCD, or specific OCD patients with SSRIs intolerance,venlafaxine extended release may be the treatment of choice, but we emphasize the importance of venlafaxine dosing strategies.