Tricyclic antidepressants in obsessive-compulsive disorder. Antiobsessional or antidepressant agents?

The response to tricyclic antidepressants of eight obsessive-compulsive patients was assessed at pretreatment and at 4, 8, and 12 weeks of treatment, with the aim of delineating differential rates of improvement, or desynchrony, between the various symptoms. Change in obsessive-compulsive symptoms paralleled change in depression and anxiety, suggesting a global beneficial effect of the drugs. The analysis of individual data also revealed this synchronous pattern of change, with significant improvement, in responders, occurring within the first 4 weeks of treatment. Furthermore, responders had higher initial Hamilton depression ratings compared to nonresponders. These results do not lend support to the claim that tricyclics possess specific antiobsessional effect which is independent of their antidepressant effect. The limitations of a purely symptomatic approach in exploring the mode of action of antidepressants in obsessive-compulsive disorder is briefly discussed.