Are there anticompulsive or antiphobic drugs? Review of the evidence

Review of 19 uncontrolled studies of antidepressants in phobic and in obsessive-compulsive disorders suggests that such drugs do not act reliably in the absence of symptoms of anxiety-depression (dysphoria). In dysphoric patients the drugs have a broad-spectrum effect, not only reducing phobias and rituals but also anxiety-depression, panic, anger, and hostility, all of which are highly intercorrelated, but none yet demonstrated to be the core disturbance. Phobics, but not obsessive-compulsives, have an unusually high dropout rate from treatment when drugs or placebo are given. When antidepressants are stopped, even after 6-8 months, relapse is likely. The drugs do not reduce the liability of many phobics and obsessive-compulsives to have dysphoric episodes over the years. Exposure treatments are not lastingly effective for phobias and for rituals, but do not reduce the liability to later dysphoric episodes.