Medication Summary
Selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) are most commonly used to treat hoarding disorder. A recent meta-analysis shows that treatment response to pharmacotherapy is similar to the response in obsessive-compulsive disorder (OCD). [23] Case reports have described success with venlafaxine and paroxetine. [24, 25] Randomized studies are needed.
Selective Serotonin Reuptake Inhibitors
Class Summary
Several SSRIs have been approved by the FDA for treatment of OCD, including sertraline, fluvoxamine, fluoxetine, and paroxetine.
Fluvoxamine (Luvox, Luvox CR)
Fluvoxamine enhances serotonin activity by selective reuptake inhibition at the neuronal membrane. It does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects than TCAs. It is FDA-approved for OCD in children (8-17 y) and adults.
Sertraline (Zoloft)
Sertraline selectively inhibits presynaptic serotonin reuptake at the neuronal membrane. It is FDA approved for the treatment of OCD, posttraumatic stress disorder, panic disorder, and social anxiety.
Fluoxetine (Prozac)
Fluoxetine selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine. It is FDA approved for depression, OCD, bulimia nervosa, and panic disorder.
Paroxetine (Paxil, Paxil CR)
Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake. It is FDA approved for depression, OCD, panic disorder, social and generalized anxiety disorders, and PTSD.
Serotonin Norepinephrine Reuptake Inhibitor
Class Summary
The dual serotonin-norepinephrine reuptake inhibitor antidepressant (SNRI) venlafaxine may also have efficacy in OCD; however, it has not yet been FDA approved specifically for the treatment of OCD.
Venlafaxine (Effexor, Effexor XR)
Venlafaxine is a serotonin/norepinephrine reuptake inhibitor. It may treat depression by inhibiting neuronal serotonin and norepinephrine reuptake. In addition, it causes beta-receptor down-regulation. It is used in the treatment of OCD; however, it is not FDA approved for this indication
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This photo shows the cluttered living space of a compulsive hoarder. Courtesy of Wikimedia Commons.
