More recently, Saxena and a colleague evaluated the efficacy and safety of venlafaxine in patients with hoarding disorder. According to Saxena, the reason they decided to evaluate venlafaxine was due to the drug’s improved safety profile in older patients as compared to paroxetine, and similar efficacy profile to paroxetine and clomipramine in the treatment of OCD.

The study was recently published in the journal International Clinical Psychopharmacology.3 “We had 23 of 24 patients complete the study, and one drop out due to the individual moving out of state. In prior research, people with hoarding disorder dropped out of treatment more often. We achieved quite good results, 35% reduction in symptoms, as good as or better than CBT studies,” said Saxena.

A key finding from this study is that venlafaxine produced these results in a shorter time period as compared to novel CBT approaches. Venlafaxine showed improvement within only 12 weeks, whereas CBT studies take ≥26 weeks and require a more involved process.


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In addition, the study demonstrated that venlafaxine also helped individuals with other comorbid psychiatric conditions including major depression and other anxiety disorders.3 “This study, in combination with previous work, indicates that certain medications work pretty well, if not better than CBT, for hoarding disorder. Seventy percent of patients were classified as responders, and that is higher than some studies of other disorders,” said Saxena.

While both paroxetine and venlafaxine showed significant improvements in hoarding and associated symptoms with treatment, Saxena said that placebo-controlled trials are necessary to truly establish the efficacy of a given treatment for a given disorder, and no placebo-controlled trials have yet been done for hoarding disorder. In addition, no other medications have been studied in a formal way for this condition.

Although CBT and paroxetine and venlafaxine have been shown to be effective in treating hoarding disorder, the effects vary among patients, and the combination of the two approaches together is likely to produce the best results as compared to using the approaches individually.

Conclusion

According to Saxena, “the take-home message is that not only is hoarding disorder very common and fairly serious, it is also very treatable. We are currently trying to educate the public about this disorder, as well as government agencies and the medical community, to get them to understand that it is not bad behavior or laziness. It requires neuropsychiatric work up and treatment. Part of the problem was that it was not previously described or categorized as a real disorder, so we are now training people how to treat it and assess it.”

Have you ever treated a patient with hoarding disorder?

References:

  1. Anxiety and Depression Association of America (ADAA). Hoarding: The Basics. Available at: http://www.adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/hoarding-basics. Accessed: April 28, 2014.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – Hoarding Disorder. http://www.dsm5.org/Documents/Obsessive%20Compulsive%20Disorders%20Fact%20Sheet.pdf. Accessed: April 28, 2014.
  3. Saxena S, Sumner J. Venlafaxine extended-release treatment of hoarding disorder. International Clinical Psychopharmacology. 2014; 00 (00); 1-8.