Pharmacologic Treatment of Obsessive-Compulsive Disorder: Comparative Studies

The predominant hypothesis about obsessive-compulsive disorder (OCD) pathophysiology implicatesabnormal serotonergic function regulation. Pharmacologic agents with potent serotoninreuptake-inhibiting properties have demonstrated effectiveness in treating OCD. In short-term clinicaltrials compared by meta-analysis, clomipramine and serotonin selective reuptake inhibitors (SSRIs)were found superior to placebo in improving symptoms of OCD. In one-to-one comparative studies,clomipramine has been found as efficacious as fluoxetine and fluvoxamine, and in a comparative trialof clomipramine with sertraline, there was a statistically superior response to sertraline after 16 weeksof treatment; moreover, discontinuation rate in patients taking clomipramine was more than twice thatin patients taking sertraline (26% vs. 11%). In contrast to patients receiving clomipramine whoshowed poor tolerance in long-term use, patients maintained on fluoxetine for 24 weeks after an acutephase well tolerated the medication. In another study, patients responding to 12 weeks of sertralinetreatment also showed improved tolerance during an additional 40-week period, with 75% completingthe continuation phase. With long-term or even lifelong treatment appearing necessary for people withOCD, those agents that result in better tolerance will prove preferable.