Table 1.
Summary of meta-analyses of clomipramine and selective serotonin reuptake inhibitors in OCD
| Study | n | Design (number of trials) | Duration | Effect on OCD |
|---|---|---|---|---|
| Greist et al75 | 1520 | PL-controlled (7) [CMI, FLX, FLV, SER] | 10–13 weeks | CMI and SSRIs >PL CMI >SSRIs No significant difference in drop-outs because of adverse effects |
| Piccinelli et al76 | 1809 | PL-controlled (26) [CMI, FLX, FLV, SER, TCA] | 5–36 weeks | CMI and SSRIs >PL CMI >SSRIs |
| Stein et al77 | 1039 | PL-controlled (12) [FLX, FLV, SER, TRZ, CMI] Head-to-head (10) Open trial (6) |
6–13 weeks | CMI and SSRIs >PL CMI = SER >FLX |
| Abramowitz78 | 20 studies with a range of 10–519 participants in each study | PL-controlled (5) [FLX, FLV, SER, CMI] Head-to-head (4) |
4–13 weeks | CMI and SSRIs >PL CMI >FLV >FLX >SER Adverse effects correlated with effect size |
| Kobak et al79 | 4641 | PL-controlled (5) [FLX, FLV, SER, CMI, PAR] Head-to-head (7) |
Not reported | CMI and SSRIs >PL CMI = FLV = FLX other SSRIs No difference in drop-out rates |
| Ackerman et al80 | 1876 | PL-controlled (18) [CMI, FLX, FLV, SER, PAR] Head-to-head (8) |
8–13 weeks | CMI and SSRIs >PL CMI = FLV = FLX = PAR |
| Soomro21 | 3097 | PL-controlled (17) [FLX, FLV, SER, PAR, CIT] | 6–13 weeks | Overall RR 1.84 (95% CI 1.56–2.17) Citalopram RR 1.58 (95% CI 1.20–2.08) Fluoxetine RR 2.41 (95% CI 1.58–4.56) Paroxetine RR 1.74 (95% CI 1.28–2.36) Sertraline RR 1.54 (95% CI 1.20–1.99) NNT 6–12 |
Abbreviations: CMI, clomipramine, FLX, fluoxetine; FLV, fluvoxamine; SER, sertraline; TRZ, trazodone; TCA, tricyclic antidepressants; PAR, paroxetine; CIT, citalopram, PL, placebo; SSRI, selective serotonin reuptake inhibitor; RR, relative risk; NNT, number-needed-to-treat, OCD, obsessive-compulsive disorder.