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Efficacy of Drug Treatment in Obsessive–Compulsive Disorder: a Meta-Analytic Review

Published online by Cambridge University Press:  02 January 2018

Marco Piccinelli ,
Stefano Pini ,
Cesario Bellantuono  and
Greg Wilkinson
Marco Piccinelli*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
Stefano Pini
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
Cesario Bellantuono
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
Greg Wilkinson
Affiliation:
University Department of Psychiatry, Royal Liverpool University Hospital, Liverpool L69 3BX
*
Dr Marco Piccinelli, Servizio di Psicologia Medica, Ospedale Policlinico, 37134 Verona, Italy. (Fax: ++39 45 585871)
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Abstract

Background

A review of the efficacy of antidepressant drug treatment in patients with obsessive–compulsive disorder (OCD), using a meta-analytic approach.

Method

Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica – Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive–compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms.

Results

Clomipramine was superior to placebo in reducing both obsessive–compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive–compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y–BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties.

Conclusion

Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive–compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive–compulsive symptoms.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 166 , Issue 4 , April 1995 , pp. 424 - 443
Copyright
Copyright © Royal College of Psychiatrists, 1995 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Amin, M. M., Ban, T. A., Pecknold, J. C., et al (1977) Clomipramine (Anafranil) and behaviour therapy in obsessive–compulsive and phobic disorders. Journal of Internal Medical Research, 5 (suppl. 5), 33–37.Google ScholarPubMed
Ananth, J., Pecknold, J. C., Van den Steen, N., et al (1981) Double-blind comparative study of clomipramine and amitriptyline in obsessive neurosis. Progess in Neuro-Psychopharmacology, 5, 257–262.CrossRefGoogle ScholarPubMed
Armitage, P. & Berry, G. (1987) Statistical Methods in Medical Research, 2nd edn. Oxford: Blackwell.Google Scholar
Balestrieri, M., Williams, P. & Wilkinson, G. (1988) Specialist mental health treatment in general practice: a meta-analysis. Psychological Medicine, 18, 711–717.Google Scholar
Begg, C. B. (1985) A measure to aid the interpretation of published clinical trials. Statistics in Medicine, 4, 1–9.CrossRefGoogle ScholarPubMed
Brand, R. & Kragt, H. (1992) Importance of trends in the interpretation of an overall odds ratio in the meta-analysis of clinical trials. Statistics in Medicine, 11, 2077–2082.Google Scholar
Cassano, G. B., Castrogiovanni, P., Mauri, M., et al (1981) A multicenter controlled trial in phobic-obsessive psychoneurosis. The effect of clomipramine and of its combinations with haloperidol and diazepam. Progress in Neuro-Psychopharmacology, 5, 129–138.Google Scholar
Chalmers, T. C., Levin, H., Sacks, H. S., et al (1987) Meta-analysis of clinical trials as a scientific discipline. I: control of bias and comparison with large cooperative trials. Statistics in Medicine, 6, 315–325.CrossRefGoogle Scholar
Chouinard, G. (1992) Sertraline in the treatment of obsessive-compulsive disorder: two double-blind, placebo-controlled studies. International Clinical Psychopharmacology, 7 (suppl. 2), 37–41.CrossRefGoogle ScholarPubMed
Chouinard, G., Goodman, W., Greist, J., et al (1990) Results of a double-blind placebo controlled trial of a new serotonin reuptake inhibitor, sertraline, in the treatment of obsessive–compulsive disorder. Psychopharmacology Bulletin, 26, 279–284.Google ScholarPubMed
Christensen, H., Hadzi-Pavlovic, D., Andrews, G., et al (1987) Behavior therapy and tricyclic medication in the treatment of obsessive–compulsive disorder: a quantitative review. Journal of Consulting and Clinical Psychology, 55, 701–711.CrossRefGoogle ScholarPubMed
Clomipramine Collaborative Study Group (1991) Clomipramine in the treatment of patients with obsessive–compulsive disorder. Archives of General Psychiatry, 48, 730–738.Google Scholar
Collins, R., Gray, R., Godwin, J., et al (1987) Avoidance of large biases in the assessment of moderate treatment effects: the need for systematic overviews. Statistics in Medicine, 6, 245–250.CrossRefGoogle ScholarPubMed
Cottreaux, J., Mollard, E., Bouvard, M., et al (1990) A controlled study of fluvoxamine and exposure in obsessive–compulsive disorder. International Clinical Psychopharmacology, 5, 17–30.CrossRefGoogle Scholar
Cottreaux, J., Mollard, E., Bouvard, M., et al (1993) Exposure therapy, fluvoxamine, or combination treatment in obsessive–compulsive disorder: one-year follow up. Psychiatry Research, 49, 63–75.CrossRefGoogle Scholar
Demets, D. L. (1987) Methods for combining randomized clinical trials: strengths and limitations. Statistics in Medicine, 6, 341–348.CrossRefGoogle ScholarPubMed
DenBoer, J. A., Westenberg, H. G. M., Kamerbeek, W. D. J., et al (1987) Effect of serotonin uptake inhibitors in anxiety disorders; a double-blind comparison of clomipramine and fluvoxamine. International Clinical Psychopharmacology, 2, 21–32.CrossRefGoogle Scholar
De Veaugh-Geiss, J., Landau, P. & Katz, R. (1989) Preliminary results from a multicenter trial of clomipramine in obsessive–compulsive disorder. Psychopharmacology Bulletin, 25, 36–40.Google Scholar
De Veaugh-Geiss, J., Moroz, G., Biederman, J., et al (1992) Clomipramine hydrochloride in childhood and adolescent obsessive–compulsive disorder – a multicenter trial. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 45–49.CrossRefGoogle ScholarPubMed
Dickersin, K., Hewitt, P., Mutch, L., et al (1985) Perusing the literature: comparison of Medline searching with a perinatal trials database. Controlled Clinical Trials, 6, 306–317.CrossRefGoogle ScholarPubMed
Easterbrook, P. J. (1992) Directory of registries of clinical trials. Statistics in Medicine, 11, 345–423.Google Scholar
Eccleston, D. (ed.) (1993) The economic evaluation of antidepressant drug therapy. British Journal of Psychiatry, 163 (suppl. 20), 5–6.CrossRefGoogle Scholar
Fiske, D. W. (1983) The meta-analytic revolution in outcome research. Journal of Consulting and Clinical Psychology, 51, 65–70.CrossRefGoogle ScholarPubMed
Flament, M. F., Rapoport, J. L., Berg, C. J., et al (1985) Clomipramine treatment of childhood obsessive–compulsive disorder. A double-blind controlled study. Archives of General Psychiatry, 42, 977–983.CrossRefGoogle ScholarPubMed
Foa, E. B. & Emmelkamp, P. M. G. (1983) Failures in Behavior Therapy. New York: John Wiley.Google Scholar
Foa, E. B., Steketee, G., Kozak, M. J., et al (1987) Imipramine and placebo in the treatment of obsessive–compulsives: their effect on depression and on obsessional symptoms. Psychopharmacology Bulletin, 23, 8–11.Google ScholarPubMed
Freeman, C. P. L., Trimble, M. R., Deakin, J. F. W., et al (in press) Fluvoxamine or clomipramine in the treatment of obsessive–compulsive disorder? A multicenter, randomized, double-blind, parallel group comparison. Journal of Clinical Psychiatry. Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989a) Efficacy of fluvoxamine in obsessive–compulsive disorder. A double-blind comparison with placebo. Archives of General Psychiatry, 46, 36–44.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989b) The Yale-Brown Obsessive Compulsive Scale, I: development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989c) The Yale-Brown Obsessive Compulsive Scale, II: validity. Archives of General Psychiatry, 46, 1012–1016.CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Delgado, P. L., et al (1990) Specificity of serotonin reuptake inhibitors in the treatment of obsessive–compulsive disorder. Comparison of fluvoxamine and desipramine. Archives of General Psychiatry, 47, 577–585.CrossRefGoogle ScholarPubMed
Goodman, W. K., McDougle, C. J. & Price, L. H. (1992) Pharmacotherapy of obsessive–compulsive disorder. Journal of Clinical Psychiatry, 53 (suppl. 4), 29–37.Google ScholarPubMed
Goodman, W. K., McDougle, C. J., Barr, L. C., et al (1993) Biological approaches to treatment-resistant obsessive–compulsive disorder. Journal of Clinical Psychiatry, 54 (suppl. 6), 16–26.Google Scholar
Greist, J. H., Jefferson, J. W., Rosenfeld, R., et al (1990) Clomipramine and obsessive–compulsive disorder: a placebo-controlled double-blind study of 32 patients. Journal of Clinical Psychiatry, 51, 292–297.Google Scholar
Greist, J. H., Chouinard, G., DuBoff, E., et al (in press) Double-blind parallel comparison of three fixed doses of sertraline and placebo in out-patients with obsessive–compulsive disorder. Archives of General Psychiatry. Google Scholar
Guscott, R. & Taylor, L. (1994) Lithium prophylaxis in recurrent affective illness. Efficacy, effectiveness and efficiency. British Journal of Psychiatry, 164, 741–746.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.Google Scholar
Hedges, L. V. (1981) Distribution theory for Glass's estimator of effect size and related estimators. Journal of Educational Statistics, 6, 107–128.CrossRefGoogle Scholar
Hewlett, W. A., Vinogradov, S. & Agras, W. S. (1992) Clomipramine, clonazepam, and clonidine treatment of obsessive–compulsive disorder. Journal of Clinical Psychopharmacology, 12, 420–430.Google Scholar
Hoehn-Saric, R., McLeod, D. R., Zimmerli, W. D., et al (1993) Symptoms and physiologic manifestations in obsessive–compulsive patients before and after treatment with clomipramine. Journal of Clinical Psychiatry, 54, 272–276.Google Scholar
Insel, T. R., Murphy, D. L., Cohen, R. M., et al (1983) Obsessive–compulsive disorder. A double-blind trial of clomipramine and clorgyline. Archives of General Psychiatry, 40, 605–612.Google Scholar
Insel, T. R., Mueller, E. A., Alterman, I., et al (1985) Obsessive–compulsive disorder and serotonin: is there a connection? Biological Psychiatry, 20, 1174–1188.CrossRefGoogle ScholarPubMed
Jaskari, M. O. (1980) Observations on mianserin in the treatment of obsessive neuroses. Current Medical Research and Opinion, 6, 128–131.CrossRefGoogle Scholar
Jenike, M. A., Baer, L., Summergrad, P., et al (1989) Obsessive–compulsive disorder: a double-blind, placebo–controlled trial of clomipramine in 27 patients. American Journal of Psychiatry, 146, 1328–1330.Google Scholar
Jenike, M. A., Hyman, S., Baer, L., et al (1990a) A controlled trial of fluvoxamine in obsessive–compulsive disorder: implications for a serotonergic theory. American Journal of Psychiatry, 147, 1209–1215.Google ScholarPubMed
Jenike, M. A., Baer, L., Summergrad, P., et al (1990b) Sertraline in obsessive–compulsive disorder: a double-blind comparison with placebo. American Journal of Psychiatry, 147, 923–928.Google Scholar
Jenike, M. A., Baer, L., Summergrad, P. & Greist, J. H. (1990c) Clomipramine versus fluoxetine in obsessive–compulsive disorder: a retrospective comparison of side-effects and efficacy. Journal of Clinical Psychopharmacology, 10, 122–124.CrossRefGoogle ScholarPubMed
Jermain, D. M. & Crismon, M. L. (1990) Pharmacotherapy of obsessive–compulsive disorder. Pharmacotherapy, 10, 175–198.Google Scholar
Kahn, R. S., Westenberg, H. G. M., Verhoeven, W. M. A., et al (1987) Effect of a serotonin precursor and uptake inhibitor in anxiety disorders; a double-blind comparison of 5-hydroxytryptophan, clomipramine and placebo. International Clinical Psychopharmacology, 2, 33–45.Google Scholar
Karabanow, O. (1977) Double-blind controlled study in phobias and obsessions. Journal of Internal Medical Research, 5 (suppl. 5), 42–48.Google ScholarPubMed
Leonard, H., Swedo, S., Rapoport, J. L., et al (1988) Treatment of childhood obsessive compulsive disorder with clomipramine and desmethylimipramine: a double-blind crossover comparison. Psychopharmacology Bulletin, 24, 93–95.Google Scholar
Leonard, H., Swedo, S., Rapoport, J. L., et al (1989) Treatment of obsessive–compulsive disorder with clomipramine and desipramine in children and adolescents. Archives of General Psychiatry, 46, 1088–1092.CrossRefGoogle ScholarPubMed
Leonard, H., Swedo, S., Lenane, M. C., et al (1993) A 2 to 7-year follow-up study of 54 obsessive–compulsive children and adolescents. Archives of General Psychiatry, 50, 429–439.CrossRefGoogle ScholarPubMed
Mallya, G. K., White, K., Waternaux, C., et al (1992) Short- and long-term treatment of obsessive–compulsive disorder with fluvoxamine. Annals of Clinical Psychiatry, 4, 77–80.CrossRefGoogle Scholar
Mantel, N. & Haenszel, W. (1959) Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute, 22, 719–748.Google Scholar
March, J. S., Gutzman, L. D., Jefferson, J. W., et al (1989) Serotonin and treatment in obsessive–compulsive disorder. Psychiatric Developments, 1, 1–18.Google Scholar
Marks, I. (1982) Are there anticompulsive or antiphobic drugs? Review of the evidence. Psychopharmacology Bulletin, 18, 78–84.Google Scholar
Marks, I. (1987) Fears, Phobias, and Rituals. New York: Oxford University Press.Google Scholar
Marks, I., Stern, R. S., Mawson, D., et al (1980) Clomipramine and exposure for obsessive–compulsive rituals: I. British Journal of Psychiatry, 136, 1–25.Google Scholar
Marks, I., Lelliott, P., Basoglu, M., et al (1988) Clomipramine, self-exposure and therapist-aided exposure for obsessive–compulsive rituals. British Journal of Psychiatry, 152, 522–534.Google Scholar
Mavissakalian, M. & Michelson, L. (1983) Tricyclic antidepressants in obsessive–compulsive disorder. Antiobsessional or antidepressant agents? Journal of Nervous and Mental Disease, 171, 301–306.CrossRefGoogle ScholarPubMed
Mavissakalian, M., Turner, S. M., Michelson, L., et al (1985) Tricyclic antidepressants in obsessive–compulsive disorder: anti-obsessional or antidepressant agents? II. American Journal of Psychiatry, 142, 572–576.Google Scholar
Mavissakalian, M., Jones, B., Olson, S., et al (1990) Clomipramine in obsessive–compulsive disorder: clinical response and plasma levels. Journal of Clinical Psychopharmacology, 10, 261–268.Google Scholar
Mawson, D., Marks, I. M. & Ramm, L. (1982) Clomipramine and exposure for chronic obsessive–compulsive rituals: III. Two year follow-up and further findings. British Journal of Psychiatry, 140, 11–18.CrossRefGoogle ScholarPubMed
Montgomery, S. A. (1980) Clomipramine in obsessional neurosis: a placebo-controlled trial. Pharmaceutical Medicine, 1, 189–192.Google Scholar
Montgomery, S. A., McIntyre, A., Osthereider, M., et al (1993) A double-blind placebo-controlled study of fluoxetine in patients with DSM–III–R obsessive–compulsive disorder. European Neuropsychopharmacology, 3, 143–152.Google Scholar
Murphy, D. L., Pickar, D. & Alterman, I. S. (1982) Methods for the quantitative assessment of depressive and manic behavior. In The Behavior of Psychiatric Patients (eds E. L. Burdock, A. Sudilovsky & S. Gershon), pp. 355–392. New York: Marcel Dekker.Google Scholar
Murphy, D. L., Pato, M. T. & Pigott, T. A. (1990) Obsessive–compulsive disorder: treatment with serotonin-selective uptake inhibitors, azapirones, and other agents. Journal of Clinical Psychopharmacology, 10, 91S–100S.Google Scholar
Pato, M. T., Pigott, T. A., Hill, J. L., et al (1991) Controlled comparison of buspirone and clomipramine in obsessive–compulsive disorder. American Journal of Psychiatry, 148, 127–129.Google Scholar
Perse, T. (1988) Obsessive–compulsive disorder: a treatment review. Journal of Clinical Psychiatry, 49, 48–55.Google Scholar
Perse, T., Greist, J. H., Jefferson, J. W., et al (1987) Fluvoxamine treatment of obsessive–compulsive disorder. American Journal of Psychiatry, 144, 1543–1548.Google Scholar
Pigott, T. A., Pato, M. T., Bernstein, S. E., et al (1990) Controlled comparison of clomipramine and fluoxetine in the treatment of obsessive–compulsive disorder. Archives of General Psychiatry, 47, 926–932.Google Scholar
Pigott, T. A., L'Heureux, F., Rubenstein, C. S., et al (1992) A double-blind, placebo controlled study of trazodone in patients with obsessive–compulsive disorder. Journal of Clinical Psychopharmacology, 12, 156–162.Google Scholar
Prasad, A. (1984) A double blind study of imipramine versus zimelidine in treatment of obsessive compulsive neurosis. Pharmacopsychiatry, 17, 61–62.Google Scholar
Prioleau, L., Murdock, M. & Brody, N. (1983) An analysis of psychotherapy versus placebo studies. Behavioral and Brain Sciences, 6, 275–310.Google Scholar
Rapoport, J. (1989) The Boy Who Couldn't Stop Washing. New York: EP Dutton.Google Scholar
Rapoport, J., Elkins, R. & Mikkelsen, E. (1980) A clinical controlled trial of chlorimipramine in adolescents with obsessive–compulsive disorder. Psychopharmacology Bulletin, 16, 61–63.Google Scholar
Rasmussen, S. A. & Eisen, J. L. (1992) The epidemiology and differential diagnosis of obsessive–compulsive disorder. Journal of Clinical Psychiatry, 53 (suppl. 4), 4–10.Google Scholar
Rasmussen, S. A. & Eisen, J. L. & Pato, M. T. (1993) Current issues in the pharmacologic management of obsessive–compulsive disorder. Journal of Clinical Psychiatry, 54 (suppl. 6), 4–9.Google Scholar
Rasmussen, S. A., Goodman, W. K., Greist, J. H., et al (in press) Fluvoxamine in the treatment of obsessive–compulsive disorder: a multicenter double-blind placebo-controlled study in outpatients. American Journal of Psychiatry. Google Scholar
Regier, D. A., Farmer, M. E., Rae, D. S., et al (1993) One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study. Acta Psychiatrica Scandinavica, 8, 35–47.Google Scholar
Ricciardi, J. M. (1993) Frequency of diagnosis of obsessive–compulsive disorder (letter). American Journal of Psychiatry, 4, 682.Google Scholar
Robins, L. N., Helzer, J. E., Weissman, M. M., et al (1984) Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry, 41, 949–958.Google Scholar
Robins, L. N. & Regier, D. A. (ed.) (1991) Psychiatric Disorders in America. The Epidemiologic Catchment Area Study, pp. 360–363. New York: The Free Press.Google Scholar
Rosenthal, R. (1979) The ‘file drawer problem’ and tolerance for null results. Psychological Bulletin, 86, 638–641.CrossRefGoogle Scholar
Rosenthal, R. (1984) Meta-analytic Procedures for Social Research. Beverly Hills: Sage.Google Scholar
Rosenthal, R. & Rubin, D. B. (1982) Comparing effect sizes of independent studies. Psychological Bulletin, 92, 500–504.CrossRefGoogle Scholar
Saiz Ruiz, J., Lopez-Ibor, J. J. Jr., Cottreaux, J., et al (1992) Double-blind comparison of fluoxetine and clomipramine in obsessive–compulsive disorder. European Neuropsychopharmacology, 2, 204–205.CrossRefGoogle Scholar
Simes, R. J. (1987) Confronting publication bias: a cohort design for meta-analysis. Statistics in Medicine, 6, 11–29.Google Scholar
Smeraldi, E., Erzegovesi, S., Bianchi, I., et al (1992) Fluvoxamine v. clomipramine treatment in obsessive–compulsive disorder: a preliminary study. New Trends in Experimental and Clinical Psychiatry, 8, 63–65.Google Scholar
Smith, M. L. & Glass, G. V. (1977) Meta-analysis of psychotherapy outcome studies. American Psychologist, 32, 752–760.Google Scholar
Smith, M. L. & Glass, G. V. & Miller, T. I. (1980) The Benefits of Psychotherapy. Baltimore: Johns Hopkins University Press.Google Scholar
Song, F., Freemantle, N., Sheldon, T. A., et al (1993) Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. British Medical Journal, 306, 683–687.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders (3rd edn). New York: New York State Psychiatric Insitute.Google Scholar
Strube, M. J. & Hartmann, D. P. (1983) Meta-analysis: Techniques, applications, and functions. Journal of Consulting and Clinical Psychology, 51, 14–27.Google Scholar
Thoren, P., Asberg, M., Cronholm, B., et al (1980) Clomipramine treatment of obsessive–compulsive disorder. I. A controlled clinical trial. Archives of General Psychiatry, 37, 1281–1285.Google Scholar
Tollefson, G. D., Rampey, A. H. & Genduso, L. A. (1993) A fixed-dose placebo-controlled trial of fluoxetine in obsessive–compulsive disorder. Proceedings of the 33rd NIMH New Clinical Drug Evaluation Unit Program (NCDEU). Boca Raton, Florida.Google Scholar
Vallejo, J., Olivares, J., Marcos, T., et al (1992) Clomipramine versus phenelzine in obsessive–compulsive disorder. A controlled clinical trial. British Journal of Psychiatry, 161, 665–670.Google Scholar
Volavka, J., Neziroglu, F. & Yaryura-Tobias, J. A. (1985) Clomipramine and imipramine in obsessive–compulsive disorder. Psychiatry Research, 14, 85–93.CrossRefGoogle ScholarPubMed
Wheadon, D. E., Bushnell, W. D. & Steiner, M. (1993) A fixed dose comparison of 20, 40, or 60 mg paroxetine to placebo in the treatment of obsessive–compulsive disorder. Poster presented at the American College of Neuropharmacology Meeting, Puerto Rico, December 1993.Google Scholar
Wilkinson, G., Balestrieri, M., Ruggeri, M., et al (1991) Meta-analysis of double-blind placebo-controlled trials of antidepressants and benzodiazepines for patients with panic disorders. Psychological Medicine, 21, 991–998.Google Scholar
Wood, A., Tollefson, G. D. & Birkett, M. (1993) Pharmacotherapy of obsessive–compulsive disorder – experience with fluoxetine. International Clinical Psychopharmacology, 8, 301–306.Google Scholar
Yaryura-Tobias, J. A., Neziroglu, F. & Bergman, L. (1976) Chlorimipramine, for obsessive–compulsive neurosis: an organic approach. Current Therapeutic Research, 20, 541–548.Google Scholar
Yusuf, S. (1987) Obtaining medically meaningful answers from an overview of randomized clinical trials. Statistics in Medicine, 6, 281–286.Google Scholar
Zohar, J. & Insel, T. R. (1987) Obsessive–compulsive disorder: psychobiological approaches to diagnosis, treatment, and pathophysiology. Biological Psychiatry, 22, 667–687.Google Scholar
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