Posted by Iansf on April 13, 2005, at 16:57:45
Morphine May Be Helpful in Refractory OCD
Reuters Health Information 2005. © 2005 Reuters Ltd.
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Although serotonin reuptake inhibitors (SRIs) are approved for treatment of OCD, up to 40% of patients fail to respond to two or more trials of such drugs, Dr. Lorrin M. Koran and his associates explain in their paper, published in the March Journal of Clinical Psychiatry.
Other small trials have suggested a role for mu-opioid receptor agonists in patients with treatment-resistant OCD, since there is a high concentration of opioid receptors in the striatal system, an area thought to be important in the pathophysiology of OCD.
For their trial Dr. Koran's group enrolled 23 subjects with OCD who had failed two to six trials of SRIs; 11 of the subjects had also not responded to atypical antipsychotic drugs. Patients were assigned, in random order, to once-weekly oral morphine sulfate (first dose 30 mg, second dose 15 to 45 mg, depending on response), lorazepam (1 mg, then 0.5 to 2 mg), or placebo, for two weeks each.
Median scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) declined from 29 to 25 during the morphine trials, and to 27 in the lorazepam trials.
Seven of 23 subjects were deemed responders to morphine based on Y-BOCS score decreases of 25% or more. There were four subjects who responded to lorazepam.
Among those responding to morphine, the most noticeable effect began the day after taking the drug and lasted for 2 to 5 days. Subjects reported decreased frequency and persistence of obsessions and anxiety, as well as an increased ability to resist their compulsions.
The authors detected no euphoric effects or disinhibition after taking the drugs, although one subject later admitted to having abused hydrocodone for several years, which he said reduced his OCD symptoms.
"The response seen, its rapidity, and the relative tolerability of the treatment are encouraging and warrant larger and longer term studies" of morphine or other mu-receptor agonists for managing treatment-refractory OCD, the authors conclude.
J Clin Psychiatry 2005;66:353-359.
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