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On the pharmacotherapy of obsessive-compulsive disorder: is a consensus possible?
C Todorov1, M H Freeston, F Borgeat
1Louis-H Lafontaine Hospital, Montreal, Quebec. todorov@medclin.umontreal.ca
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.
Method:
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.
Conclusion:
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.