REVIEW OF: Shamabadi A et al, Psychiatry Clin Neurosci 2024;78:810–817

STUDY TYPE: RCT

Although there are effective therapies for OCD, many patients suffer from residual symptoms. Inflammation seems to be implicated for at least some patients with the disorder, and several researchers have looked at whether anti-inflammatory therapies can reduce symptoms. This double-blinded study examined the role of adjunctive naproxen, an NSAID, in combination with fluoxetine for adult patients with OCD. 

The researchers excluded patients who were already on active treatment for OCD or who had medical contraindications such as GI bleeding or kidney disease. The average participant was 33 years old, had severe OCD as evidenced by a Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) score of 30, and had received SSRIs previously. Inflammatory biomarkers were not assessed. A total of 104 patients were randomized to either fluoxetine (starting at 20 mg/day and titrated to 80 mg/day) plus either naproxen (250 mg twice daily) or placebo. Patients were assessed with the Y-BOCS again at 5 and 10 weeks.

Patients randomized to naproxen had statistically significant improvements at both time points, and on the obsession subscale score at 10 weeks. 80% of the naproxen group had a response, defined as an over 35% reduction on the Y-BOCS scale, compared to 50% of the control group. Remission rates were not different between groups. Naproxen was well tolerated. 

CARLAT TAKE
For these relatively healthy young adults with OCD, adding naproxen to antidepressants helped. If you try naproxen, make sure the patient doesn’t have medical comorbidities, like GI bleeding or kidney problems, that place them at greater risk of side effects.