[Trends in drug therapy of obsessive-compulsive disorders]

Within different drug treatment strategies in obsessive-compulsive disorder (OCD) namely selective serotonin reuptake inhibitors (SSRI) (e.g. Fluoxetine max. 60 mg/die as well as Clomipramin 200 mg/die) have conveyed consistent benefit. In the case of non-response after an adequate treatment of 10-12 weeks it should be switched on alternative serotonergic antidepressants. If a persistent non-response results a so-called "augmentation treatment" is recommended. The principle of augmentation consists in an increase of activity resulting from combination of serotonin agonists (e.g. Buspiron) with SSRIs. The combination of monoaminoxidase inhibitors (MAOI) with SSRIs--in the literature often described as effective in treatment resistant OCD--is inadvisable and strictly contra-indicated (cave: Serotonin-Syndrome). In some cases monotherapy with MAOI seems effective (Schmauss et al., 1993). For this, it has to be regarded that a restriction period is given (e.g. 5 weeks after a pre-going Fluoxetine treatment). The combination of SSRIs and alternative serotonergic antidepressants with neuroleptics is only effective in cases of "spectrum disorders" and comorbidity (namely Gilles-de-la-Tourette-Syndrom). The use of neuroleptics in OCD should be strictly limited.