Pharmacotherapy for obsessive-compulsive disorder

Area of Science:

• Psychiatry
• Pharmacology

Background:

• Pharmacotherapy for obsessive-compulsive disorder (OCD) was limited before the advent of potent selective serotonin reuptake inhibitors (SSRIs).
• Advances in pharmacotherapy have significantly improved treatment efficacy for a majority of OCD patients.

Purpose of the Study:

• To review the current landscape of pharmacotherapy for obsessive-compulsive disorder.
• To evaluate the efficacy and tolerability of various pharmacological interventions for OCD.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) for OCD pharmacotherapy.
• Inclusion of data from open trials and case reports detailing beneficial pharmacotherapy.

Main Results:

• Selective serotonin reuptake inhibitors (SSRIs) demonstrate good tolerability in OCD patients, even at high doses.
• Antipsychotic augmentation shows promise for OCD patients with comorbid tics, whereas proserotonergic augmentation is generally less effective.
• Potent SSRIs are the preferred pharmacotherapy for OCD, with monoamine oxidase inhibitors having a secondary role.

Conclusions:

• Potent SSRIs are the first-line pharmacotherapy for obsessive-compulsive disorder.
• Switching to a different SSRI may be beneficial if initial treatment is ineffective.
• Behavioral therapy and, in refractory cases, neurosurgery are important adjunctive or alternative treatments for OCD.