A risk-benefit assessment of drugs used in the management of obsessive-compulsive disorder.
Established efficacy and tolerability in large multicentre controlled studies have made serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SRIs) the mainstay of monotherapy for adult obsessive-compulsive disorder (OCD). When compared with the selective serotonin reuptake inhibitors (SSRIs), the tricyclic compound clomipramine has a higher incidence of adverse effects but is well tolerated by most OCD patients and may confer the best overall antiobsessional effects. Consideration of specific adverse effect profiles, special patient population characteristics, drug interactions and relative cost of the various agents may direct clinicians in choosing the most appropriate first-line drug. Alternative agents as monotherapies have been explored, but none has consistently proven effective to date. Investigations of SRI augmentation with serotonin-enhancing agents have also failed to demonstrate substantial benefits for treatment-refractory OCD. Combination treatment with SRIs and dopamine receptor antagonist drugs appears to provide an improved response for the subpopulation of OCD patients who have comorbid 'tic-spectrum' disorders, though large-scale studies of the efficacy and tolerability of these regimens are not yet available.
Carpenter
L L
LL
Yale University Department of Psychiatry, Abraham Ribicoff Research Facilities, Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, USA.
McDougle
C J
CJ
Epperson
C N
CN
Price
L H
LH
D015057:1-Naphthylamine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D002065:Buspirone / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002997:Clomipramine / Q000009:adverse effects / Q000627:therapeutic use; D002998:Clonazepam / Q000009:adverse effects / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D018492:Dopamine Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D004361:Drug Tolerance; D005277:Fenfluramine / Q000009:adverse effects / Q000627:therapeutic use; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use; D016666:Fluvoxamine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008094:Lithium / Q000009:adverse effects / Q000627:therapeutic use; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy*; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D020280:Sertraline; D014364:Tryptophan / Q000009:adverse effects / Q000627:therapeutic use
D015057:1-Naphthylamine; D000928:Antidepressive Agents; D002065:Buspirone; D002997:Clomipramine; D002998:Clonazepam; D018492:Dopamine Antagonists; D005277:Fenfluramine; D005473:Fluoxetine; D016666:Fluvoxamine; D008094:Lithium; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; D014364:Tryptophan