Pharmacological management of obsessive-compulsive disorder: a review for clinicians.
Obsessive-compulsive disorder (OCD) has been treated pharmacologically with drugs that enhance availability of the neurotransmitter serotonin. This review summarizes the available literature on the pharmacological treatments of OCD. Numerous randomized controlled trials have attested to the efficacy of serotonin-reuptake inhibitors (SRIs) in treating this disorder, although a coherent model of serotonin dysfunction in OCD has not been established. Meta-analyses of randomized controlled trials have found better results with clomipramine than with other SRIs, but comparative studies have so far not replicated this finding. Aspects of the methodology in these studies that might explain this discrepancy are considered. Tolerability, side effects, dosing, and safety during pregnancy of the SRIs are discussed. Treatment of OCD with poor insight and of OCD comorbid with a tic disorder, augmentation strategies, and management of partial response to SRIs are reviewed. Finally, the available interventions for refractory OCD are considered.
McDonough
M
M
Maudsley Hospital, Denmark Hill, London, England. sbpmdm@iop.kcl.ac.uk
Kennedy
N
N
D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004334:Drug Administration Schedule; D004351:Drug Resistance; D006801:Humans; D015201:Meta-Analysis as Topic; D019635:Neurosurgical Procedures; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000523:psychology / Q000601:surgery; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors