Abstract
Established efficacy and tolerability in large multicentre controlled studies have made serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SRIs) the mainstay of monotherapy for adult obsessive-compulsive disorder (OCD). When compared with the selective serotonin reuptake inhibitors (SSRIs), the tricyclic compound clomipramine has a higher incidence of adverse effects but is well tolerated by most OCD patients and may confer the best overall antiobsessional effects. Consideration of specific adverse effect profiles, special patient population characteristics, drug interactions and relative cost of the various agents may direct clinicians in choosing the most appropriate first-line drug. Alternative agents as monotherapies have been explored, but none has consistently proven effective to date. Investigations of SRI augmentation with serotonin-enhancing agents have also failed to demonstrate substantial benefits for treatment-refractory OCD. Combination treatment with SRIs and dopamine receptor antagonist drugs appears to provide an improved response for the subpopulation of OCD patients who have comorbid 'tic-spectrum' disorders, though large-scale studies of the efficacy and tolerability of these regimens are not yet available.
Publication types
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Research Support, Non-U.S. Gov't
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Research Support, U.S. Gov't, P.H.S.
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Review
MeSH terms
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1-Naphthylamine / adverse effects
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1-Naphthylamine / analogs & derivatives
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1-Naphthylamine / therapeutic use
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Adult
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Aged
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Antidepressive Agents / adverse effects
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Antidepressive Agents / therapeutic use
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Buspirone / adverse effects
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Buspirone / therapeutic use
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Child
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Clomipramine / adverse effects
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Clomipramine / therapeutic use
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Clonazepam / adverse effects
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Clonazepam / therapeutic use
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Costs and Cost Analysis
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Dopamine Antagonists / adverse effects
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Dopamine Antagonists / therapeutic use
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Drug Interactions
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Drug Tolerance
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Fenfluramine / adverse effects
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Fenfluramine / therapeutic use
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Fluoxetine / adverse effects
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Fluoxetine / therapeutic use
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Fluvoxamine / adverse effects
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Fluvoxamine / therapeutic use
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Humans
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Lithium / adverse effects
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Lithium / therapeutic use
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Obsessive-Compulsive Disorder / drug therapy*
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Paroxetine / adverse effects
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Paroxetine / therapeutic use
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Risk Assessment
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Selective Serotonin Reuptake Inhibitors / adverse effects
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Selective Serotonin Reuptake Inhibitors / therapeutic use
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Sertraline
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Tryptophan / adverse effects
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Tryptophan / therapeutic use
Substances
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Antidepressive Agents
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Dopamine Antagonists
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Serotonin Uptake Inhibitors
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Fluoxetine
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Fenfluramine
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Paroxetine
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Clonazepam
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Tryptophan
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1-Naphthylamine
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Lithium
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Clomipramine
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Fluvoxamine
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Sertraline
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Buspirone