Pharmacotherapy for obsessive-compulsive disorder

Advances in pharmacotherapy in the past decade have provided clinicians wit h many safe and effective medications for the treatment of patients with ob sessive-compulsive disorder. Serotonin reuptake inhibitors, including the s elective serotonin reuptake inhibitors, and clomipramine are the first-line pharmacologic therapies for patients with obsessive-compulsive disorder. T reatment with serotonin reuptake inhibitors is unique in that a selective e fficacy exists, a longer therapeutic lag occurs, and higher doses often pro duce clinically significant relief to most patients. These medications are not effective in all patients, and although they alleviate the symptoms of obsessive-compulsive disorder, however, they do not cure it. No one seroton in reuptake inhibitor has been demonstrated to be superior to the others in head-to-head trials. Because 40% to 60% of patients do not respond to adeq uate treatment trials of serotonin reuptake inhibitors, augmentation strate gies, including serotonergic and other neurotransmitter mechanisms, are for serotonin reuptake inhibitor partial and nonresponders.