Obsessive Compulsive Disorders by Stein Bsc (Med) MBChB FRCPC Dan J

Author:Stein Bsc (Med) MBChB FRCPC, Dan J
Language: eng
Format: mobi
Tags: Bioscience & Clinical Medicine
Publisher: Informa Healthcare
Published: 2007-03-14T04:00:00+00:00

Table 9.1 Practical questions for OCD pharmacotherapy.

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What kind of drug?

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What dose?

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What are the side effects?

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What about comorbidity?

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How long should treatment continue, and what happens if treatment is discontinued?

Table 9.2 The pharmacological specificity of OCD.

Effective as monotherapy

Potent SRIs such as clomipramine, fluvoxamine, fluoxetine, sertraline, paroxetine and citalopram

Potential as agents of augmentation in combination with SRIs

Conventional antipsychotics such as haloperidola

Atypical antipsychotics such as risperidone,b olanzapinec

Pindolold

Ineffective

Tricyclic antidepressants (apart from clomipramine)

Monoamine oxidase inhibitors

Lithium

Benzodiazepines

Buspirone

Electroconvulsive therapy

aEffective in OCD with comorbid tics.4

bEffective in the absence of comorbid tics.5

cEfficacy not yet established in controlled studies.

dPositive and negative findings from controlled studies.6,7

The selectivity of the pharmacological response distinguishes OCD from the other anxiety disorders and from depression in which both noradrenergic and serotonergic medications appear to be equally potent.

Although the pharmacological data indicate a role for serotonin in the pathophysiology of OCD, neurobiological research has failed to produce consistent findings. It appears increasingly unlikely that the illness results from a specific abnormality in serotonin neurotransmission, and there may well be a variety of different biochemical abnormalities underpinning the disorder.

If this is the case, why then are the SRIs uniquely effective? Serotonin is understood to play an important role in modulating stress. Instead of repairing a specific serotonergic lesion, it is possible that the SRIs work in OCD by enhancing fundamental neuropsychological defence systems, which rely on serotonin activity to function adequately.8

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