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Ask the Mental Health Expert Archives 2001-2004

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OCD Medicines

Q. I was wondering if you know of the effectiveness of Ultram or morphine for Obsessive-Compulsive Disorder (OCD)? There have been several studies that indicate that it may be an effective treatment for refractory OCD. What are your thoughts?

A. I am not aware of any randomized, double-blind, placebo-controlled studies showing that either Tramadol [Ultram] or morphine are useful in treating OCD. Since this type of study is the "gold standard" for scientific research, I'd have to say I remain a skeptic until I see such evidence. That said, I am aware of open studies and case reports finding that opiate-like agents (this includes Tramadol, though this drug also has effects similar to Prozac and other SSRIs) may be useful in some cases of severe, refractory OCD. In Dr. Lorrin Koran's excellent text, "Obsessive-Compulsive and Related Disorders in Adults" (Cambridge, 1999), he summarizes a few of the studies done with opiates. For example, Warneke (1997) reported on the benefits of oral morphine every 5-8 days, in five severely refractory OCD patients. Koran has observed some benefits with oral codeine, though lasting only a few hours. Some interesting new data on Tramadol for OCD has come from the clinic of Dr. Nathan Shapira, at the University of Cincinnati [for details, log on to http://medcenter.uc.edu/news/cTramadol.ucm]. Although Dr. Shapira has not reported randomized, double-blind, placebo-controlled studies, he has observed that, "In some patients, Tramadol can even take affect and decrease symptoms within 30 minutes to an hour. Traditional drugs used to treat these illnesses have to be taken for at least 8-12 weeks before any response is apparent. This drug is unique in that it can be taken on an as-needed basis and can have an immediate response time." Perhaps so, but I await the "gold standard" studies! Given the addictive risks associated with opiates and related agents, I think we all need to be cautious with this approach.

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January 2004

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