Drug treatment of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is an uncommon but difficult to manage problem. Behaviour therapy is the treatment of choice, with clomipramine as an adjunct in patients with coexisting depression. However, the incidence of side effects with the doses required (up to 200 mg daily, or occasionally higher) is high, and the side effects may be intolerable to some patients. Benzodiazepines have no effect on the core symptoms of OCD, and their usefulness as long term anxiolytics is outweighed by the risks of physical and psychological dependence. There is no place for antipsychotic drugs in managing obsessive-compulsive disorder.