On the pharmacotherapy of obsessive-compulsive disorder: is a consensus possible?
OBJECTIVE
To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive-compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials.


METHODS
The literature on the pharmacotherapy of OCD was critically examined.


RESULTS
The available research evidence is not conclusive but suggests that clomipramine possesses greater anti-obsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs.


CONCLUSIONS
Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.
Todorov
C
C
Louis-H Lafontaine Hospital, Montreal, Quebec. todorov@medclin.umontreal.ca
Freeston
M H
MH
Borgeat
F
F
D002997:Clomipramine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005104:Expert Testimony; D005473:Fluoxetine / Q000627:therapeutic use*; D016666:Fluvoxamine / Q000627:therapeutic use*; D017408:Guidelines as Topic; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D016896:Treatment Outcome
D002997:Clomipramine; D005473:Fluoxetine; D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline