Pharmacologic therapy of obsessive compulsive disorder

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Obsessive-Compulsive Disorder (OCD) was historically considered rare and challenging to treat.
• Early evidence in 1967 suggested serotonergic drugs, like clomipramine, could be effective for OCD symptoms.
• Increased awareness of OCD prevalence and effective treatments spurred significant research interest.

Purpose of the Study:

• To review the evidence supporting the serotonergic hypothesis in OCD pathophysiology and treatment.
• To evaluate the efficacy of various pharmacologic treatments for OCD, particularly serotonin reuptake inhibitors.
• To explore the potential role of adjunctive serotonergic therapies in enhancing treatment outcomes.

Main Methods:

• Review of controlled trials and multicenter studies on pharmacologic treatments for OCD.
• Meta-analytic techniques applied to data from controlled trials of serotonin reuptake inhibitors.
• Examination of studies investigating other serotonergic drugs as potential OCD treatments.

Main Results:

• Pharmacologic treatments, including clomipramine and selective serotonin reuptake inhibitors (SSRIs) like fluvoxamine, sertraline, and fluoxetine, are more effective than placebo for OCD.
• Clomipramine demonstrated a slightly larger effect size compared to SSRIs in meta-analyses.
• While SSRIs are effective for many, some patients require alternative or adjunctive treatments for adequate symptom relief and complete remission.

Conclusions:

• Serotonin reuptake inhibitors are established treatments for OCD.
• Clomipramine appears to have a stronger effect than SSRIs, but both are valuable.
• Further investigation into adjunctive serotonergic therapies is warranted to improve treatment efficacy for non-responders and achieve complete remission.