Efficacy and Safety of Fluvoxamine alone and in combination with L-Methyltetrafolate in patients with Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a disabling condition consisting of bothersome

intrusive thoughts that elicit a feeling of discomfort. The prevalence of OCD is on the rise,

according to current trends the global prevalence ranges from 1.6% to 2.3%.1 The

symptoms in 50% cases often first appear in childhood and adolescent. The average age of

onset is 19.5 years.2 The prevalence in India is approximately 1%3 and roughly 90% of

those with OCD have coexisting psychiatric diagnoses, most commonly are anxiety

disorders.2

OCD is characterized by significant impairment of cognitive-behavioral inhibition, which

is associated with cognitive processes evoking anxiety, along with an increased desire for

perfect control over the possible harm.3

As per International Classification of Diseases (ICD) 11 obsessive compulsive and related

disorders includes olfactory reference syndrome, body dysmorphic disorder, bodily

focused repetitive behaviour disorder, hoarding disorder, hypochondriasis.10

Selective Serotonin Reuptake Inhibitors (SSRIs) along with Exposure and Response

Prevention (ERP) are the cornerstones of treatment for OCD. The initial line of treatment

for OCD is SSRIs like sertraline, paroxetine, fluvoxamine, and fluoxetine.4

Fluvoxamine is effective in treating OCD, and was the first SSRI to be approved for this

use. It blocks reuptake of serotonin at the sodium-dependent serotonin transporter (SERT)

of the neuronal membrane, enhancing actions of serotonin on 5HT1A autoreceptors.7 The

initial daily dose of fluvoxamine is 50 mg and the dose is further increased to100 mg if a

patient shows no improvement after 2 weeks of initiation of treatment. The maximum dose

prescribed is upto 250 mg depending on the improvement.7

Folate plays an important role in carbon transfer metabolism (methylation), required for

the synthesis of serotonin and other monoamine neurotransmitters as well ascatecholamines.5 Low folate levels are associated with mental illnesses like primarily

affective and psychotic disorders.6

In resistant cases of OCD, L-methyl tetrahydrofolate has been evaluated to the augment the

effect of fluvoxamine. However, there is scarcity of data regarding the additional benefit

effect of L- methyl tetrahydrofolate and it will be important to see the effect of

fluvoxamine in OCD patient when L-methyl tetrahydrofolate is used as an augmentation

strategy from the start of treatment. Hence, the current study is planned to assess the

efficacy and safety of fluvoxamine alone and in combination with L- methyl

tetrahydrofolate as add on therapy in patients of OCD