Evidence-based pharmacotherapy of obsessive–compulsive disorder

• Published in: The international journal of neuropsychopharmacology Vol. 8; no. 1; pp. 107 - 129
• Main Authors: Fineberg, Naomi A., Gale, Tim M.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.03.2005; Oxford University Press
• Subjects: Antidepressive Agents, Tricyclic - therapeutic use; Clomipramine - therapeutic use; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Meta-Analysis as Topic; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - drug therapy; Obsessive-Compulsive Disorder - psychology; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Serotonin Uptake Inhibitors - therapeutic use; Special Series; Treatment Outcome; Obsessive–compulsive disorder; pharmacological treatment; review
• ISSN: 1461-1457; 1469-5111
• DOI: 10.1017/S1461145704004675

Obsessive–compulsive disorder is a prevalent and disabling lifespan disorder. Clomipramine and the SSRIs have been found to be effective across the range of symptoms, both in acute and longer-term studies. Meta-analyses have reported a larger treatment effect for clomipramine relative to the SSRIs, but this is not supported by evidence from head-to-head comparator studies and, based on their superior safety and tolerability, SSRIs are the preferred option for long-term treatment in most cases. The treatment-effect is usually gradual and partial, and many patients fail to respond adequately to first-line treatment. Pharmacological options for refractory cases include switching SRI, increasing the dose, or augmenting with an antipsychotic agent. Novel strategies are under investigation for this highly morbid group. This paper reviews the key questions related to OCD pharmacotherapy, synthesizing evidence derived from randomized controlled trials, meta-analyses and consensus guidelines.