On the pharmacotherapy of obsessive-compulsive disorder: Is a consensus possible?

Objective: To en:amine the efficacy and tolerability of clomipramine compar ed with the selective serotonin reuptake inhibitors (SSRIs) in the treatmen t of obsessive-compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 faile d SSRI trials. Method: The literature on the pharmacotherapy of OCD was critically examine d. Results: The available research evidence is not conclusive but suggests tha t clomipramine possesses greater antiobsessional efficacy than do the SSRIs . In addition, when clomipramine is presented to patients in a positive way , and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs. Conclusion: Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research ev idence. Both clomipramine and the SSRIs may be used as first-line treatment s for OCD.