title: Longitudinal course of pharmacotherapy in obsessive-compulsive disorder.
abstract: BACKGROUND
  Although data fully support the use of serotonin reuptake inhibitors (SRIs) in the treatment of obsessive-compulsive disorder (OCD), investigations on pharmacotherapy discontinuation during the course of OCD are lacking. This 5-year prospective study sought to better understand the long-term course of SRI utilization among individuals with OCD.
  
  
  METHODS
  A total of 252 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. OCD, treated with medication in the community, were examined for discontinuation and resumption of SRIs. Data on weekly OCD symptoms, medications, and dosage changes were obtained annually using the Longitudinal Interval Follow-up Evaluation.
  
  
  RESULTS
  During the 5-year follow-up period, 151 patients had at least one trial of an SRI for 12 weeks or more. A total of 110 patients (43.7%) discontinued their medication (i.e. ceased taking medication for ≥4 weeks) at least once during the follow-up period. In patients symptomatic at the time of discontinuation, the cumulative incidence of worsening of OCD after SRI discontinuation was 9.8%, whereas in patients in partial or full remission at the time of discontinuation, the corresponding cumulative incidence was 33.3%. Among patients with worsening of OCD upon SRI discontinuation, the median time to worsening was 39 weeks.
  
  
  CONCLUSIONS
  This first longitudinal study on the use of SRIs in OCD found that patients who had achieved partial or full remission on SRIs were less likely to discontinue medication, and the cumulative incidence of worsening of OCD after discontinuation was negatively associated with OCD severity at the time of SRI discontinuation.
authors.affiliation: Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois 60637, USA.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Grant
authors.forename: Maria C
authors.initials: MC
authors.lastname: Mancebo
authors.forename: Eric
authors.initials: E
authors.lastname: Weinhandl
authors.forename: Brian L
authors.initials: BL
authors.lastname: Odlaug
authors.forename: Jane L
authors.initials: JL
authors.lastname: Eisen
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003155:Community Mental Health Centers; D039721:Diagnostic and Statistical Manual of Mental Disorders; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000517:prevention & control; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors