Serotonergic antidepressants and their efficacy in obsessive compulsive disorder

Since 1985, major advances have been made in the pharmacologic treatment of obsessive compulsive disorder. Clomipramine is undoubtedly effective. Other selective serotonin reuptake inhibitors, such as fluvoxamine and sertraline, seem effective as well. Fluoxetine's efficacy has been principally based on convincing open-label studies and clinical practice. No large controlled studies have been published. A preliminary analysis of a double-blind trial in which 51 obsessive compulsive disorder patients were randomly assigned to either placebo or three fixed doses of fluoxetine reveals that the drug is decisively helpful. Unexpectedly, the 20-mg/day dose was as effective as the 40- or 60-mg/day dose. Although these findings further advance our understanding of short-term pharmacologic treatments, few data are available regarding maintenance doses, relapse, and efficacy of adjunctive treatments.