Obsessive-compulsive disorder: treatment with serotonin-selective uptake inhibitors, azapirones, and other agents

Obsessive-compulsive disorder (OCD) has recently been recognized as a relatively common disorder, affecting one in 40 individuals in the United States. OCD has also been demonstrated to be at least partially drug-responsive, although fewer than 20 adequate, fully controlled treatment trials in OCD patients have been reported, all in the last decade. The partially selective serotonin (5-hydroxytryptamine, 5-HT) uptake inhibitor clomipramine has been the most studied drug and uniformly has been found to be of some benefit in patients with OCD. Several recent controlled trials with other, more highly selective 5-HT uptake inhibitors have also shown these drugs to be more effective than placebo. More recently, preliminary data from several studies have questioned whether buspirone, an azapirone with prominent 5-HT-related anxiolytic and possible antidepressant properties, may have direct therapeutic effects in OCD patients or may be a useful adjunct when used in combination with the selective 5-HT uptake inhibitor fluoxetine. These studies are reviewed briefly and evaluated in the context of investigations that used other drugs with serotonergic actions either alone or in combination with selective 5-HT uptake inhibitors in OCD patients.