Paroxetine effective in treating patients with compulsive hoarding syndrome

In a paper published on-line in advance of publication in the Journal of Psychiatric Research, Sanjaya Saxena, M.D., Director of the Obsessive-Compulsive Disorders (OCD) Program at the University of California, San Diego (UCSD) School of Medicine, reports the surprising finding that the serotonin reuptake inhibitor (SRI) medication, paroxetine, is effective in treating patients with compulsive hoarding syndrome.

The study of 79 patients diagnosed with obsessive-compulsive disorder (OCD) - 32 of them with compulsive hoarding syndrome - suggests that further controlled trials of SRI medications for compulsive hoarding are now warranted.

Compulsive hoarding, which may affect up to 2 million people in the United States, is found in people with many diseases, including anorexia, schizophrenia, Alzheimer's disease and dementia. It is most often found in patients with OCD, though researchers are not yet sure if it is a subtype of OCD or a separate disorder.

In previous, retrospective studies - looking at patients and data from past drug trials - compulsive hoarding had been associated with poor response to SRI medications commonly used to treat OCD patients. However, no previous study had ever directly tested this widely held theory. Saxena's prospective study, comparing the hoarding and non-hoarding OCD patients, showed nearly identical responses to paroxetine (commonly known as Paxil.) The symptoms exhibited by patients in both groups improved significantly with treatment.

Compulsive hoarding patients exhibit three core features: failure to discard objects due to severe anxiety related to discarding what most might regard as inconsequential objects; excessive acquisition, sometimes resulting in buying sprees; and excessive clutter to the point where home and work spaces can no longer be used. They also display marked indecisiveness, disorganization, and procrastination. Sometimes such patients are only discovered when a landlord, social worker or fireman enters a home in which every available surface - floors, tables, sofas and beds - is covered with clutter making the space inhabitable.

"The syndrome is driven by obsessional fears of not having items you might need, or of losing something valuable, as well as overly sentimental attachments to objects." said Saxena.

Compulsive hoarding is a psychiatric disorder with brain abnormalities that can be seen and measured, according to Saxena, whose research focuses on the neurobiology (brain abnormalities) and treatment of OCD and related mood and anxiety disorders. He points out that the disorder is treatable through a combination of medication and therapy. Saxena and colleagues at UCSD recently opened a new clinic in La Jolla to treat patients with OCD and related disorders, including compulsive hoarding.

Saxena was formerly director of the UCLA Neuropsychiatric Institute's OCD Research Program, where he and his research team used positron emission tomography (PET) brain imaging to discover distinct patterns of brain activity that were associated with compulsive hoarding but not found in non-hoarding OCD patients. Preliminary data from their brain studies also suggest that people with compulsive hoarding are more likely to have mild atrophy or an unusual shape to their frontal lobes, which is the part of the brain associated with executive functions and decision-making. In a few months, the UCSD team will begin a new PET study of compulsive hoarding, as well as a study of hoarding in patients over 55.

"The vast majority of compulsive hoarders have had problems for many years before seeking help," Saxena said, with symptoms that worsen over time. "As patients age and live independently, they may become isolated, and the hoarding syndrome can spin out of control."