Pharmacotherapy of primary obsessive-compulsive disorder: review of the literature

Obsessive-compulsive disorder (OCD) is a chronic illness that affects 2-3% of Americans during their lifetime. It is characterized by recurrent obtrusive thoughts (obsessions) that compel patients to perform repetitive behaviors that can be excessively time consuming and cause marked distress. More than 40 controlled trials have been published on the treatment of OCD. Of drugs available to treat the disorder, serotonin reuptake inhibitors (SRIs) are most studied. With SRIs, symptoms improve in 22-62% of patients, but complete remission is rare. An agent is often selected based on side effects and patient tolerance, since SRIs are all equally effective. If no response is seen with average dosages, dosages should be increased to the maximum within 4-8 weeks from starting treatment. In patients with partial response, the dosage should be increased to the maximum by 5-9 weeks. Before determining the effectiveness of therapy, a trial of 8-13 weeks is necessary.