title: Biological approaches to treatment-resistant obsessive compulsive disorder.
abstract: Biological approaches to the patient with treatment-resistant obsessive compulsive disorder are briefly reviewed. The most commonly employed strategy involves combining a potent serotonin reuptake inhibitor (SRI) (e.g., clomipramine or fluvoxamine) with another medication that may exert effects on the brain serotonin system. Open-label reports regarding the addition of tryptophan, fenfluramine, lithium, or buspirone to ongoing SRI therapy of obsessive compulsive disorder are encouraging. However, the anti-obsessive compulsive efficacy of SRI-lithium and SRI-buspirone combination therapy has not been confirmed in recent controlled trials. Preliminary evidence suggests that addition of neuroleptic may benefit SRI-refractory obsessive compulsive disorder patients who have a comorbid chronic tic disorder. Other biological approaches (e.g., electroconvulsive therapy and psychosurgery) are considered in terms of their narrowly defined roles in the treatment of patients with SRI-resistant obsessive compulsive disorder. Finally, an algorithm is proposed for those patients with obsessive compulsive disorder who fail to respond to an adequate trial with a potent SRI.
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06519.
authors.forename: W K
authors.initials: WK
authors.lastname: Goodman
authors.forename: C J
authors.initials: CJ
authors.lastname: McDougle
authors.forename: L C
authors.initials: LC
authors.lastname: Barr
authors.forename: S C
authors.initials: SC
authors.lastname: Aronson
authors.forename: L H
authors.initials: LH
authors.lastname: Price
mesh_terms: D001521:Behavior Therapy; D002065:Buspirone / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003663:Decision Trees; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D005277:Fenfluramine / Q000627:therapeutic use; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000628:therapy*; D010789:Phototherapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012892:Sleep Deprivation; D014196:Trazodone / Q000627:therapeutic use; D014364:Tryptophan / Q000627:therapeutic use
chemical_list: D002065:Buspirone; D002998:Clonazepam; D005277:Fenfluramine; D008094:Lithium; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone; D014364:Tryptophan