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A review of pharmacologic treatments for obsessive-compulsive disorder Kaplan A; Hollander EPsychiatr Serv 2003[Aug]; 54 (8): 1111-8OBJECTIVE: Obsessive-compulsive disorder is a chronic and often disabling disorder that affects 2 to 3 percent of the U.S. population. Optimal treatment involves a combination of pharmacologic and cognitive-behavioral therapies. Advances in psychopharmacology have led to safe and effective treatments for obsessive-compulsive disorder that provide clinically significant improvement in symptoms. In this article the authors review studies of pharmacologic treatments. METHODS: A MEDLINE search was conducted to identify relevant articles from 1991 to 2002. Double-blind, placebo-controlled studies as well as open-label studies and case reports were included. RESULTS AND DISCUSSION: The serotonin reuptake inhibitors (SRIs), including clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive-compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents. Clomipramine and the selective serotonin reuptake inhibitors (SSRIs) are first-line agents. However, 40 to 60 percent of patients with obsessive-compulsive disorder do not respond to adequate treatment trials with SRIs, and agents that alter serotonin receptors and other neurotransmitter systems, such as dopamine, norepinephrine, and second-messenger systems, may play a role in treatment. Treatment options for patients who do not respond to SRIs include switching, augmentation, or novel-agent strategies. Up to two-thirds of patients with obsessive-compulsive disorder have comorbid psychiatric disorders, which may present a challenge in pharmacologic treatment. Major depressive disorder is the most common comorbid condition. Nonpharmacologic invasive techniques may play a role in refractory cases of obsessive-compulsive disorder, but further research is warranted.|Antidepressive Agents, Tricyclic/adverse effects/pharmacology/*therapeutic use[MESH]|Chronic Disease[MESH]|Clinical Trials as Topic[MESH]|Clomipramine/adverse effects/therapeutic use[MESH]|Comorbidity[MESH]|Humans[MESH]|Obsessive-Compulsive Disorder/*drug therapy[MESH]|Selective Serotonin Reuptake Inhibitors/adverse effects/pharmacology/*therapeutic use[MESH]|Treatment Outcome[MESH] |
