Venlafaxine in Obsessive-compulsive Disorder-Reply

In Reply Yaryura-Tobias and Neziroglu have thoughtfully presented their experience with a small, double-blind, placebo-controlled trial of venlafaxine as a treatment for OCD. They note trends toward efficacy and suggest that the failure to find statistically significant differences is related to the short duration of their trial (8 weeks) and low doses of venlafaxine hydrochloride (225 mg/d, maximum dose). They are correct that a longer duration of treatment would be needed to conclude that venlafaxine was ineffective as a treatment for OCD, as most potent serotonin-reuptake inhibitors studied to date have showed continued improvement beyond 8 weeks. Whether higher doses of venlafaxine are needed is less clear, and their assertion that mean daily doses of fluoxetine and sertraline were "at or near the manufacturers' recommended maximum for treating patients who have depression" is inaccurate. Both fluoxetine and sertraline were effective at low doses (20 and 50 mg/d, respectively) and exhibited a flat