New research has found that certain antidepressants work well to reduce symptoms of compulsive hoarding.
It’s very common to have a collection of some kind acquiring and retaining nonessential objects is nearly universal and found throughout history. But some individuals develop abnormal hoarding behavior. Compulsive hoarding involves collecting or failing to get rid of vast numbers of objects to the point where they cause significant clutter and problems moving around the house, cooking, cleaning or sleeping.
Compulsive hoarders often buy much more than they need, and feel severe anxiety at the thought of discarding these objects. Hoarding is linked to indecisiveness, disorganization and procrastination, and many diseases such as anorexia, schizophrenia, Alzheimer’s disease and dementia. It is estimated to affect up to 2 million people in the U.S.
Compulsive hoarding is closely associated with obsessive-compulsive disorder (OCD), but may be a separate disorder. It is also related to obsessive-compulsive personality disorder, and impulse control disorder, but compulsive hoarders may show no other symptoms of these conditions.
In previous research studies, patients have not responded well to serotonin reuptake inhibitor (SRI) medications often given to people with OCD, but a team from the University of California, San Diego decided to directly test these drugs on hoarders.
Sanjaya Saxena, M.D., and colleagues recruited 79 OCD patients, of whom 32 of had compulsive hoarding syndrome. All participants received paroxetine (Paxil) alone for a mean of 80 days. Both groups “improved significantly with treatment” when tested on OCD symptoms, depression, and anxiety.
“There were no significant differences between groups in the proportions of patients who completed or responded to treatment,” the team reported, adding that hoarding symptoms improved as much as other OCD symptoms.
This suggests that SRI medications are effective for compulsive hoarding, the researchers concluded, and they called for further trials of SRI drugs for this condition.
Saxena has previously researched both the brain abnormalities and treatment of OCD. Compulsive hoarding is a psychiatric disorder with distinguishing brain abnormalities. Using positron emission tomography (PET), Saxena discovered distinct patterns of brain activity that were associated with compulsive hoarding but not found in non-hoarding OCD patients.
According to Saxena, “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. The vast majority of compulsive hoarders have had problems for many years before seeking help, 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.” But the disorder is treatable through a combination of medication and therapy.
Saxena’s findings could lead to a reassessment of the consensus that current serotonergic medications for OCD are largely ineffective for treating hoarding, as stated in a review in 2003.
The reviewers, from Boston University, pointed out that hoarding patients are underrepresented in research, partly because they often refuse treatment possibly due to poor insight or low motivation.
Many studies conclude that hoarders have a poor response to SRIs and require alternative treatments. They often report that patients benefit more from drugs together with cognitive behavior therapy (CBT), than drugs alone. One promising option may be a form of CBT designed to address the distinctive problems associated with the condition.
Motivational treatments and relapse-prevention methods also may help. But further studies on large groups of patients whose primary problem is hoarding, regardless of OCD symptoms, are needed to find out whether such a specialized CBT treatment would be effective.
Saxena, S. et al. Paroxetine treatment of compulsive hoarding. Journal of Psychiatric Research, published online June 21, 2006.
Frost, R. and Steketee, G. Compulsive hoarding: Current status of the research. Clinical Psychology Review, Vol. 23, December 2003, pp. 905-27.