TY - JOUR
T1 - Obsessive-compulsive disorder has a reduced placebo (and antidepressant) response compared to other anxiety disorders
T2 - A meta-analysis
AU - Sugarman, Michael A.
AU - Kirsch, Irving
AU - Huppert, Jonathan D.
N1 - Funding Information: Work on this study was partially funded by Israel Science Foundation Grant 1698/15 to JDH. The authors would like to thank Isaac Fradkin and Asher Strauss for comments on earlier versions of the manuscript. They would also like to thank Ymkje de Vries and Annelieke Roest for graciously sharing data from approval documents they obtained from the FDA/FOIA. Publisher Copyright: © 2017
PY - 2017/8/15
Y1 - 2017/8/15
N2 - Background Previous studies have indicated that obsessive-compulsive disorder (OCD) might have a reduced placebo response compared to other anxiety-related disorders including generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder. No previous analysis has directly compared antidepressant and placebo responses between OCD and these conditions. Method We analyzed pre-post change scores within drug and placebo groups as well as between-groups change scores (i.e., drug compared to placebo) for all FDA-approved antidepressants for the treatment of these five anxiety-related disorders. Antidepressants included duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine. Random effects meta-analysis was used to examine all trials submitted to the FDA, plus additional post-approval trials available from manufacturer-sponsored clinical trial registers. Clinician-rated symptom inventories were the outcome measures for all conditions to facilitate comparisons across diagnoses. Results Fifty-six trials met inclusion criteria. OCD had significantly lower pre-post effect sizes (ps<0.003) for both placebo (Hedges' g=0.49) and antidepressants (g=0.84) compared to the other four conditions (gs between 0.70 and 1.10 for placebo and 1.11 and 1.40 for antidepressants). However, the drug-placebo effect sizes did not significantly differ across diagnoses (Q(4)=6.09, p=0.193, I2 =34.3% [95% CI: −7.0,59.7]), with gs between=0.26 and 0.39. Conclusions Overall pre-post change scores were smaller for OCD compared to other anxiety disorders for both antidepressants and placebo, although drug-placebo effects sizes did not significantly differ across disorders. Theoretical and clinical implications for the understanding and treatment of OCD are discussed.
AB - Background Previous studies have indicated that obsessive-compulsive disorder (OCD) might have a reduced placebo response compared to other anxiety-related disorders including generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder. No previous analysis has directly compared antidepressant and placebo responses between OCD and these conditions. Method We analyzed pre-post change scores within drug and placebo groups as well as between-groups change scores (i.e., drug compared to placebo) for all FDA-approved antidepressants for the treatment of these five anxiety-related disorders. Antidepressants included duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine. Random effects meta-analysis was used to examine all trials submitted to the FDA, plus additional post-approval trials available from manufacturer-sponsored clinical trial registers. Clinician-rated symptom inventories were the outcome measures for all conditions to facilitate comparisons across diagnoses. Results Fifty-six trials met inclusion criteria. OCD had significantly lower pre-post effect sizes (ps<0.003) for both placebo (Hedges' g=0.49) and antidepressants (g=0.84) compared to the other four conditions (gs between 0.70 and 1.10 for placebo and 1.11 and 1.40 for antidepressants). However, the drug-placebo effect sizes did not significantly differ across diagnoses (Q(4)=6.09, p=0.193, I2 =34.3% [95% CI: −7.0,59.7]), with gs between=0.26 and 0.39. Conclusions Overall pre-post change scores were smaller for OCD compared to other anxiety disorders for both antidepressants and placebo, although drug-placebo effects sizes did not significantly differ across disorders. Theoretical and clinical implications for the understanding and treatment of OCD are discussed.
KW - Antidepressants
KW - Anxiety
KW - Anxiety disorders
KW - Meta-analysis
KW - Obsessive-compulsive disorder
KW - Placebo
UR - http://www.scopus.com/inward/record.url?scp=85018950671&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jad.2017.04.068
DO - https://doi.org/10.1016/j.jad.2017.04.068
M3 - Review article
C2 - 28477500
SN - 0165-0327
VL - 218
SP - 217
EP - 226
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -