Giving a patient with schizophrenia that also suffers from obsessive-compulsive disorder (OCD) the fibromyalgia drug milnacipran led to a rapid reduction in OCD symptoms, according to a case study from Taiwan.
Shan Hung, MD and Galen Chin-Lun Hung, MD, ScM, both of the Taipei City Psychiatric Center, write in the Journal of Clinical Psychopharmacology, that they encountered a 23-year-old male who had been diagnosed with schizophrenia and OCD four years prior. The man was on a regimen of 225mg/d of quetiapine (Seroquel) and 20mg/d of escitalopram (Lexapro). While the man’s psychotic symptoms stabilized his OCD did not.
The man’s drug regimen was then switched to 15 mg/day of aripiprazole (Abilify) and the escitalopram was raised to 30 mg/day. However, the OCD symptoms still persisted after five months on the regimen.
The psychiatrists then decided to switch out the escitalopram, a selective serotonin re-uptake inhibitor, with milnacipran (Savella), a serotonin–norepinephrine reuptake inhibitor. Milnacipran was initially given at 100mg/d, but was raised to 150 mg/d by the third week. No other psychological or behaviorial interventions were made.
Results showed that at the end of the first week, the patient’s score on the Yale-Brown Obsessive Compulsive Scale dropped dramatically and was sustained through the 12th week. He did not report any adverse effects.
“Milnacipran, with its preferable noradrenergic reuptake blockade, can be a reasonable alternative if [obsessive and compulsive symptoms] fail to respond to SSRIs or other SNRIs,” they concluded.
One fourth of patients with schizophrenia experience comorbid obsessive and compulsive disorders (OCSs), and half of the patients fulfill the criteria for obsessive-compulsive disorder (OCD).