The psychopharmacology of obsessive compulsive disorder. Implications for treatment and pathogenesis.
Recent advances in the pharmacotherapy of obsessive compulsive disorder (OCD) have led to a significant reduction in suffering and a return to productive living for many patients previously considered refractory to treatment. Potent inhibitors of 5-hydroxytryptamine (5-HT) re-uptake clearly have been established as the first-line pharmacotherapy for treatment of OCD. The addition of agents that enhance 5-HT neurotransmission to ongoing treatment in patients whose OCD is refractory to 5-HT re-uptake inhibitors has not yielded impressive results. The addition of dopamine (DA) antagonists to the regimens of treatment-resistant patients appears to be a potentially useful strategy for the specific subgroup of OCD patients with a comorbid chronic tic disorder such as Tourette's syndrome. Pharmacologic studies suggest that both the 5-HT and DA systems may be critical to the treatment and possibly the pathophysiology of OCD.
McDougle
C J
CJ
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Goodman
W K
WK
Leckman
J F
JF
Price
L H
LH
D001521:Behavior Therapy / Q000379:methods; D001921:Brain / Q000187:drug effects / Q000502:physiology; D003131:Combined Modality Therapy; D004298:Dopamine / Q000502:physiology; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012701:Serotonin / Q000502:physiology; D005879:Tourette Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology
D011619:Psychotropic Drugs; D012701:Serotonin; D004298:Dopamine