Pharmacotherapy of obsessive-compulsive disorder

Due to its chronic and refractory nature, a wide variety of medications have been used in the treatment of obsessive-compulsive disorder (OCD). The most promising development has been with the tricyclic antidepressant clomipramine (Anafranil). More recently, a series of well controlled double blind studies have documented that clomipramine is more effective than placebo in reducing OCD symptoms. In a review of all 7 CMI studies with a total of 106 patients, two-thirds were found to be significantly improved on blind ratings (Insel and Zohar, 1988). Controlled studies also suggest clomipramine is more effective than other antidepressants for the treatment of OCD. Oral m-CPP (m-chlorophenyl piperazine), a selective 5HT agonist, has been found to increase obsessions in OCD patients when given acutely (Zohar, 1987; Hollander, 1988). This effect has been shown to decrease after chronic treatment with clomipramine (Zohar et al., 1988) or fluoxetine (Hollander et al., unpublished observations), suggesting that chronic treatment may correct serotonin dysregulation.