SNRIs pharmacological alternatives for the treatment of obsessive compulsive disorder?

Obsessive compulsive disorder can be a challenging psychiatric phenomenon to diagnose and treat. At the present time, recommended treatment strategies include cognitive behavioral therapy (e.g., exposure and response prevention) and pharmacotherapy (e.g., selective serotonin reuptake inhibitors and clomipramine). Unfortunately, even with adequate pharmacotherapy, only 70 percent of patients improve, indicating the clinical need for pharmacological alternatives. Such alternatives may presently exist in the group of antidepressants classified as serotonin-norepinephrine reuptake inhibitors. Although large, double-blind, placebo-controlled studies are lacking, preliminary evidence through case reports and small studies suggests potential efficacy for three currently available serotonin-norepinephrine reuptake inhibitors (e.g., venlafaxine, duloxetine, milnacipran). If genuinely efficacious, serotonin-norepinephrine reuptake inhibitors would be likely to have fewer side effects than clomipramine and might be a reasonable second-line alternative to selective serotonin reuptake inhibitors. Only further research will clarify the role of serotonin-norepinephrine reuptake inhibitors in the treatment of obsessive compulsive disorder.