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Refractory obsessive-compulsive disorder: state-of-the-art treatment
Eric Hollander1, Carol A Bienstock, Lorrin M Koran
1Department of Psychiatry, Compulsive, Impulsive, and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY 10029, USA. eric.hollander@mssm.edu
Abstract:
Nonresponse to treatment in obsessive-compulsive disorder is common, associated with substantial impairment, and understudied. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded well to 2 trials of selective serotonin reuptake inhibitors (SSRIs). Available options include continuation of SSRI treatment, switching to another SSRI or selective serotonin-norepinephrine reuptake inhibitor, augmenting with atypical neuroleptics or cognitive-behavioral therapy, or utilizing novel treatment approaches. The authors synthesize state-of-the-art treatment and give practical advice for clinicians.
Insights
Treatment-resistant obsessive-compulsive disorder (OCD) affects many, yet guidance is limited. This review offers clinicians practical strategies for patients not responding to selective serotonin reuptake inhibitors (SSRIs).
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Nonresponse to treatment is common in obsessive-compulsive disorder (OCD).
- This presents significant impairment and is understudied.
- Clinicians lack practical advice for managing treatment-resistant OCD after selective serotonin reuptake inhibitor (SSRI) failure.
Purpose of the Study:
- To synthesize current treatment options for patients with OCD who have not responded to two trials of SSRIs.
- To provide practical, evidence-based advice for clinicians on next-step treatment strategies.
Main Methods:
- Literature synthesis of state-of-the-art treatments for treatment-resistant OCD.
- Review of pharmacological and psychotherapeutic strategies.
Main Results:
- Several next-step options exist: continuing SSRI, switching SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs), augmentation with atypical antipsychotics or cognitive-behavioral therapy (CBT), or novel approaches.
- No single strategy is universally superior; choice depends on individual patient factors.
Conclusions:
- Effective management of treatment-resistant OCD requires a systematic approach.
- Clinicians can utilize a range of strategies beyond initial SSRI trials to improve patient outcomes.