PHARMACOTHERAPY OF OBSESSIVE-COMPULSIVE DISORDER

Obsessive-compulsive disorder (OCD) is a chronic and often incapacitat ing disorder that is frequently complicated by mood and additional anx iety diagnoses. Although appropriate pharmacotherapy is often of great benefit, full remission is rare. Separate multi-center, placebo-contr olled trials; a clomipramine, paroxetine, fluoxetine, sertraline and f luvoxamine, respectively, have established the unparalleled efficacy a nd safety of the serotonin reuptake inhibitors (SRIs) in the treatment of OCD. Direct comparisons of SRIs suggest similar efficacy, but redu ced tolerability for clomipramine in comparison to fluoxetine, fluvoxa mine, sertraline and paroxetine in patients with OCD. Although 60-80% of OCD patients will respond to SRI treatment, partial symptom reducti on (mean improvement, 25-40% from baseline) remains the rule. Controll ed trials of adjuvant lithium, buspirone, thyroid hormone or clonazepa m added to ongoing SRI therapy have failed to demonstrate substantial further antiobsessive effects. The presence of comorbid conditions, sp ecific OCD symptom content and various other clinical features have be en investigated as potential predictors of medication response in pati ents with OCD, but consistent factors have not yet been identified. Cl inical experience and preliminary data does suggest that a lack of res ponse to one or more SRIs does not preclude response to another SRI. A n overview of the pharmacotherapy of OCD, including first-line medicat ion(s) and the comparative efficacy and pharmacological features of th e different SRIs will be presented in this review, as well as potentia l strategies for OCD patients who fail to respond to conventional phar macotherapeutic interventions.