Efficacy and tolerability of pharmacotherapy for obsessive-compulsive personality disorder: a systematic review of randomized controlled trials

ABSTRACT

Introduction

Although obsessive-compulsive personality disorder (OCPD) is one of the most prevalent personality disorders, it is one of the least studied. There is debate as to whether pharmacotherapy is efficacious for OCPD. We aimed to systematically evaluate the efficacy and tolerability of pharmacotherapy for OCPD.

Areas covered

This systematic review found two randomized controlled trials investigating pharmacotherapy of OCPD. In a study of major depression (n = 308) with comorbid OCPD (n = 71), citalopram was more effective for OCPD than sertraline with fewer drop-outs from treatment. In a small study of OCPD (n = 24), fluvoxamine was more effective than placebo, and there was a low drop-out rate. Risk of bias and quality assessment of these studies was not possible, and findings have very low levels of certainty.

Expert opinion

Two studies provide preliminary evidence in support of citalopram and fluvoxamine for OCPD. Further randomized controlled trials are required before firm conclusions can be drawn regarding efficacy of pharmacotherapy for OCPD.

KEYWORDS:

• Anankastic personality disorder
• antidepressants
• drug treatment
• efficacy
• obsessive-compulsive personality
• pharmacology
• pharmacotherapy

Article highlights

• Only two randomized controlled trials studies have investigated the potential beneficial effects of pharmacotherapy for OCPD;

• There is preliminary evidence of the efficacy and tolerability of citalopram and fluvoxamine for OCPD; and findings have very low levels of certainty;

• There is a need for high quality randomized controlled trials evaluating the efficacy and tolerability of pharmacotherapy for DSM-5 and ICD-11 OCPD.

Declaration of interest

J Gecaite-Stonciene serves as a consultant at FACITrans. DJ Stein has received research grants and/or consultancy honoraria from Discovery, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Sano Servier, Takeda and Vistagen. T Williams has previously received funding from the SAMRC Unit on Risk and Resilience in Mental Disorders. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

CL and DJS are supported by the SAMRC.