Update on Pharmacologic Management of OCD: Agents and Augmentation

A preponderance of patients with obsessive-compulsive disorder (OCD) experience little or no improvementin their symptoms when treated with serotonin reuptake inhibitors (SRIs). It is hypothesizedthat SRI-refractory patients may have altered serotonin neurotransmission different frompatients responsive to SRIs, or that they may have abnormalities in their dopamine function. Whendrugs affecting serotonin function (e.g., tryptophan, fenfluramine, lithium, buspirone) are added toSRI therapy in SRI-refractory patients, results are mixed and not consistently encouraging. However,when drugs affecting dopamine function (e.g., pimozide, haloperidol, risperidone) are added to SRItherapy in SRI-refractory OCD patients, individuals with either a personal history or family history oftics experience a reduction in their symptoms.