Obsessive Compulsive Disorder: When to Discontinue Treatment?

Q: Patient with diagnosis of obsessive compulsive disorder is stable on Fluvoxamine and CBT treatment. Y-BOCS also confirmed that patient is in remission. Patient is asking you if he can discontinue or lower the dose of Fluvoxamine.
How long should a successful medication treatment for OCD be continued for before considering a gradual taper?

 


 

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APA 2007 guideline recommends that successful medication treatment for OCD be continued for 1–2 years before considering a gradual taper.

 


Study Supporting Continuation of Active Treatment:

  • Meta-analysis compared data from five double blind discontinuation studies.
  • Relapse occurred in 22.7% subjects on active treatment versus 41.6% placebo group.

 


Risk of Discontinuation at <12 months:

  • Study found that discontinuing successful augmentation after 1–12 months resulted in relapse for more than 80% (15/18) of patients.
  • Most within 2 months of discontinuation.

Source:

  1. American Psychiatric Association. Practice guideline for the treatment of patients with obsessive compulsive disorder. Arlington, VA: American Psychiatric Association, 2007.
  2. J Affect Disord. 2010 Jun;123(1-3):9-16.
  3. Int Clin Psychopharmacol 2003; 18:23–28.

 

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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