Effective Pharmacotherapy for Obsessive–Compulsive Disorder in Adults

Lawrence H Price, Laura Whiteley
European Psychiatric Review, 2010;3(2):58-62
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Abstract

Obsessive–compulsive disorder (OCD) is the fourth most common psychiatric illness and the 10th leading cause of disability in the world, rendering it a major medical and public health issue. This article reviews the most recent English language literature on effective pharmacotherapy for OCD. Preference was given to randomised, double-blind, placebo-controlled trials published in the last 20 years and listed on PubMed. In cases where no such studies exist, other case-controlled, open-label or single-blind approaches were reviewed. Treatment of drug-resistant OCD was reviewed with emphasis on literature published in the past five years. The tricyclic antidepressant clomipramine and a variety of selective serotonin reuptake inhibitors (SSRIs) have been found efficacious for OCD in randomised placebo-controlled trials. Optimisation of a primary drug treatment is the preferred approach to initial non-response before switching agents. Augmentation of first-line treatment in OCD has been attempted with many agents, but reliable efficacy has been shown only with neuroleptics. Newer methods of treatment, such as neuromodulatory and neurosurgical approaches and pharmacological facilitation of cognitive behavioural therapy (CBT), are currently under investigation. Potent serotonin reuptake inhibitors remain the first-line pharmacotherapeutic approach to OCD. In choosing among these and available second-line treatments, the side-effect profiles of available agents deserve careful attention. The most important aspect of effective management of OCD is a persistent and methodical approach.
Keywords
Obsessive–compulsive disorder, treatment, serotonin reuptake inhibitors
Disclosure Lawrence H Price has received grants and/or research support from Medtronic, Neuronetics, Cyberonics, the National Institutes of Health (NIH), the Department of Defense (DOD) and the Health Resources and Services Administration (HRSA), and has consulted for Gerson Lehrman, Wiley, Springer and Abbott. He has nothing to declare in relation to this article. Laura Whiteley has no conlicts of interest to declare.
Received: September 26, 2007 Accepted February 19, 2010
Correspondence: Lawrence H Price, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, US. E: lawrence_price_md@brown.edu

Obsessive–compulsive disorder (OCD) is estimated to affect between 2 and 3% of the general population. The disorder is the fourth most common psychiatric illness, following only specific phobia, substance abuse and major depression.1,2 In the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), diagnosis is based on the presence of either obsessions (recurrent or persistent unwanted thoughts, images or impulses) or compulsions (repetitive behaviours or mental acts often performed to relieve anxiety or distress) that the person has recognised at some point during the illness as excessive or unreasonable and that cause marked distress, take up more than one hour a day or significantly interfere with the person’s normal routine, occupational functioning or usual social activities or relationships. In most cases both obsessions and compulsions are present, and functional impairment can be profound. The impact of OCD on public health is underscored by estimates that it is the 10th leading cause of disability in the world.3–5

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