Pharmacotherapy for the Treatment of Hoarding Disorder

Hoarding disorder, which is characterized by difficulty discarding or parting with possessions, is common and potentially “disabling.” In fact, this behavior usually has some harmful effects, such as emotional, physical, social, financial, and even legal implications. Also, people who hoard often exhibit irrational behavior.

In some studies, hoarding has been listed as diagnostic criteria for obsessive-compulsive personality disorder (OCPD); however, some consider hoarding a disorder in itself. There are various routes of treatment for hoarding disorder, including both psychotherapy and pharmacotherapy. For the purpose of this assignment, I will focus more on the pharmacotherapy.

Since hoarding disorder is closely associated with OCD, pharmacotherapy for the treatment of hoarding disorder is similar to treatment of OCD. Studies have shown that OCD patients respond well to the use of selective serotonin reuptake inhibtors (SSRI’s), and some of these drugs have clinical effect in patients with hoarding behavior/disorder. In one study done by Sanjaya Saxena, it was concluded that the use of paroxetine (Paxil),¬†which is an SSRI, improved hoarding symptoms, depression, and anxiety. Furthermore, venlafaxine has also shown good response with hoarding behaviors. In fact, venlafaxine had a trend for greater reduction in hoarding symptoms than that seen with paroxetine. New treatment strategies might also include cognitive enhancers, such as donepezil, to increase attention and executive functioning in patients with hoarding disorder.

In conclusion, hoarding disorder is a common and relevant problem that can tremendously affect someone’s life, but can be treated. Hoarding disorder, along with its signs and symptoms, can be improved by pharmacologic therapy (mostly the use of SSRI’s), psychological therapy, or a combination of both.

 

http://www.uspharmacist.com/content/d/pharmacy_focus/c/58008/

Saljoughian, Manouchehr. Hoarding Disorder: Diagnosis and Treatment. US Pharm. 2015:40(11):60-62.

Specific SSRIs and birth defects: bayesian analysis to interpret new data in the context of previous reports

The focus of this study was to reanalyze previous studies using Bayesian analysis to determine which SSRIs, if any, were associated with different types of birth defects.

The study took place across 10 centers in the U.S., with almost 18,000 mothers of infants who did not experience birth defects and almost 10,000 mothers of infants who did experience birth defects. The study then looked to see if these mothers had used citalopram, escitalopram, fluoxetine, paroxetine, or sertraline in the month before pregnancy through the third month of pregnancy. The study was adjusted to take into accound race/ethnicity, education level, smoking, and obesity of the mother.

The study concluded that the most commonly used SSRI was sertraline, but no birth defects could be correlated to the use of this drug. There were also no defects strongly correlated with citalopram or escitalopram. The researchers concluded that some birth defects did occur 2-3.5 times more frequently in the infants of women using paroxetine or fluoxetine early in pregnancy.

This study is interesting to me, as it gives us a better guideline of which SSRIs are safer to use in pregnant women. If the switch from one type of SSRI can dramatically reduce the risk of birth defect, I think most mothers would be happy to know this and would be very likely to switch medications.

Link to Article