Hoarding: Drug Treatment

This is the fourth post examining the problem of hoarding. In the first post, I reviewed some of the characteristics of people with animal hoarding behavior.  The second post examined some of the common co-occuring mental disorders in those with hoarding.   The third post looked at some evidence that the BDNF gene status may contribute to hoarding and also be linked in increased risk of obesity.


In this post, I will comment on the use of  pharmacotherapy as a part of a treatment program for hoarding.  Saxena recently published a review of the research literature of drug treatment of hoarding and also outlined results from a small open label study of the drug venlafaxine.  


Saxena reports that his group performed the only study specifically designed to assess the response of compulsive hoarding behaviors to a selective serotonin reuptake inhibitor (paroxetine) compared to a control group of individuals with OCD but no hoarding compulsions.


SSRI drugs have been the most promising group of agents for the treatment of OCD.  However, only about one third of those with OCD report a response approaching remission criteria when treated with an SSRI.  An additional third report partial improvement in symptoms while the remaining third appear to have no response to SSRIs.


There is some anecdotal reports claiming that hoarding symptoms in OCD predict a poorer response of OCD to SSRI therapy.  However, in the Saxena et al study of paroxetine for hoarding the following outcome was noted:

• The OCD response rates were similar in the hoarding (28%) and the non-hoarding (32%) OCD groups
• Hoarding symptoms were reduced by 24% with paroxetine (similar to response size in other OCD symptom clusters)
• There was no finding of a correlation between the severity of hoarding symptoms and treatment response
• A significant number of hoarders (and non-hoarders) were unable to tolerate the higher doses often needed in OCD populations

The Saxena review then summarizes an open-label trial of venlafaxine (Trade name Effexor in the U.S.) in thirteen hoarders.  Venlafaxine is a serotonin reuptake inhibitor as well as a norepinephrine reuptake inhibitor at higher doses.  Preliminary results in this sample suggest good response of hoarding behaviors in some individuals with a trend for greater reduction in hoarding symptoms compared to the paroxetine.

These manuscripts support consideration of use of an SSRI or venlafaxine type antidepressants in those with significant hoarding behaviors.  A comprehensive program that includes drug therapy, individual behavior therapy, family education and assistance with clutter clean up may be needed for the most severe cases of hoarding.


Molecular model of the antidepressant drug venlafaxine is in the public domain from Wikimedia Commons authored by Benjah-bmm27.


Saxena, S. (2011). Pharmacotherapy of compulsive hoarding Journal of Clinical Psychology, 67 (5), 477-484 DOI: 10.1002/jclp.20792