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Use of vortioxetine in treating obsessive-compulsive disorder: a case report

Published online by Cambridge University Press:  27 August 2024

B. Jiménez-Fernández*
Affiliation:
Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
N. V. Motta-Rojas
Affiliation:
Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
X. Iborra-Vicheto
Affiliation:
Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
J. Cuevas-Esteban
Affiliation:
Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
*
*Corresponding author.

Abstract

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Introduction

Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.

Objectives

To evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.

Methods

Clomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.

Results

The dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.

The pre and post results are summarized in tables 1 and 2.Table 1.

Hamilton Depresion Rating Scale (0-52)

BasalPost 10-week treatment
214

Dimensional Y-BOCS (0-15)

BasalPost 10-week treatment
Aggressive-related obsessions and compulsions102
Religious-related obsessions and compulsions51
Symmetry and order71
Pollution and cleaning00
Collecting and accumulation20
Miscellaneous103

Conclusions

Vortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.

Disclosure of Interest

None Declared

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of European Psychiatric Association
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