LONG-TERM TREATMENT OF OBSESSIVE-COMPULSIVE DISORDER

The efficacy of clomipramine and selective serotonin (5-hydroxytryptam ine; 5-HT) reuptake inhibitors (SSRIs) in treating obsessive-compulsiv e disorder (OCD) is now established. However, few studies are availabl e on long term treatment strategies in patients with OCD. In this arti cle, recent literature on drug discontinuation and maintenance treatme nt of OCD is reviewed and discussed. All studies which have evaluated recurrence rates after drug discontinuation have found that up to 80% of patients who respond to SSRIs relapse if the medication is withdraw n. The studies that have been performed on long term treatment of OCD with both clomipramine and SSRIs show that patients who continue medic ation maintain and slightly increase the level of improvement achieved in short term trials. Several authors suggest that, in maintenance tr eatment, drug dosages can be reduced to between 40 and 60% of those us ed in acute episodes without a significant difference in symptom impro vement. Preliminary data concerning drug tolerability in patients rece iving long term treatment for OCD indicate that SSRIs are well tolerat ed, and that the rate of adverse effects tends to decrease compared wi th short term treatment. Several recent reports suggest that patients who have taken SSRIs for at least 2 months are at risk of developing w ithdrawal symptoms when treatment is discontinued. However, no data ar e available concerning the relationship between the duration of OCD tr eatment and the onset of withdrawal symptoms.