A RISK-BENEFIT ASSESSMENT OF DRUGS USED IN THE MANAGEMENT OF OBSESSIVE-COMPULSIVE DISORDER

Established efficacy and tolerability in large multicentre controlled studies have made serotonin (5-hydroxytryptamine; 5-HT) reuptake inhib itors (SRIs) the mainstay of monotherapy for adult obsessive-compulsiv e disorder (OCD). When compared with the selective serotonin reuptake inhibitors (SSRIs), the tricyclic compound clomipramine has a higher i ncidence of adverse effects but is well tolerated by most OCD patients and may confer the best overall antiobessional effects. Consideration of specific adverse effect profiles, special patient population chara cteristics, drug interactions and relative cost of the various agents may direct clinicians in choosing the most appropriate first-line drug . Alternative agents as monotherapies have been explored, but none has consistently proven effective to data. Investigations of SRI augmenta tion with serotonin-enhancing agents have also failed to demonstrate s ubstantial benefits for treatment-refractory OCD. Combination treatmen t with SRIs and dopamine receptor antagonist drugs appears to provide an improved response for the subpopulation of OCD patients who have co morbid 'tic-spectrum' disorders, though large-scale studies of the eff icacy and tolerability of these regimens are not yet available.