Combination of fluoxetine and nortriptyline in the treatment of obsessive compulsive disorders

ABSTRACT

There is growing interest in investigating noradrenergic functions in Obsessive Compulsive Disorder [OCD] because some antidepressants with strong effects of serotonin reuptake inhibition fail to relieve obsessive-compulsive symptoms. We undertook a trial to investigate whether the combination of fluoxetine with nortriptyline is more effective than fluoxetine alone. Thirty nine patients who met the DSM-IV criterias for OCD were included in the study. Patients were allocated in a random fashion, 19 patients to fluoxetine 40mg/day plus nortriptyline 40mg/day and 20 patients to fluoxetine 40mg/day plus placebo. Although both protocols significantly decreased the scores of the Yale-Brown obsessive-compulsive scale over the trial period, the combination of fluoxetine and nortriptyline showed a significant superiority over fluoxetine alone in the treatment of OCD. As this study indicates, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic-serotoninergic hypothesis in OCD