Table 2.
Clinical and demographic characteristics of SRI-refractory OCD patients treated with agomelatine 50 mg/day for a minimum of 3 months
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | |
|---|---|---|---|---|---|---|
| Age | 35 | 44 | 66 | 53 | 25 | 33 |
| Age at onset | 23 | 36 | 57 | 20 | 15 | 24 |
| Gender | M | M | F | F | M | F |
| DSM-IV Axis-I comorbidities | Resistant MDD, social anxiety disorder | Impulse-control disorder, substance abuse disorder | None | Bulimia nervosa, panic disorder | None | Panic disorder |
| First-degree relatives family history | Bipolar disorder II (brother) | ADHD (son) | None | None | None | None |
| Side effects | Weight gain (BMI 32 to 34 within 3 months) | None | None | None | None | Dizziness (initial, spontaneously remitting) |
| Last failed SRI trial | Fluoxetine 60 mg/day | Sertraline 200 mg/day | Fluoxetine 60 mg/day | Amitriptyline 300 mg/day | Fluvoxamine 250 mg/day | Duloxetine 120 mg/day + CBT |
| Main clinical features/OC symptoms | Doubt/compulsive shopping | Belching compulsion | Religious/touching | Hoarding/insertion of thought and intrusive images with sexual contents/checking | Checking/repeating | Fear of losing control toward food (in absence of BED) |
| Y-BOCS total score (baseline to week 12) | Not modified | Remission: 21 to 9 | Not modified | Not modified | Remission: 32 to 11 | Remission: 22 to 8 |
| Actual, subjective circadian rhythms impairment (BRIAN) | Any relevant disruptions | Reported stable insomnia | Any relevant disruptions | Any relevant disruptions | Reported daily hypersomnia and nocturnal awakening | Any relevant disruptions |
| Lifetime bipolar spectrum signs (TEMPS-A at week 12) | Cyclothymic temperament | Anxious temperament | Any specific | Cyclothymic temperament | Any specific | Any specific (but presence of PD) |
| Poor insight feature (BABS, baseline-week 12) | No (stable) | Yes→No | No (stable) | No (stable) | No (stable) | No (stable) |
Patient 6 received CBT within the 3 month trial with agomelatine; psychotherapy had already been established at least 6 months earlier.
ADHD = attention deficit hyperactivity disorder; BABS = Brown Assessment of Beliefs Scale; BED = Binge Eating Disorder; BMI = body mass index; BRIAN = Biological Rhythms Interview of Assessment in Neuropsychiatry; CBT = cognitive behavioral therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition; MDD = major depressive disorder; SRI = serotonin reuptake inhibitor; OC = obsessive compulsive; PD, panic disorder; TEMPS-A = Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego lifetime Autoquestionnaire; Y-BOCS = Yale-Brown Obsessive Compulsive Scale.