Treatment Options for Obsessive-Compulsive Disorder

Drug Therapy for Obsessive-Compulsive Disorder

Cognitive-behavioral therapy is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD). Drug therapy is usually reserved for children and adolescents who fail to demonstrate an improvement in their OCD symptoms following initial cognitive-behavioral therapy.

For adult patients with OCD, cognitive-behavioral therapy or drug therapy may be offered as first-line treatment. In some cases, a combination of cognitive-behavioral therapy and drug therapy may be considered as an initial approach for treatment of OCD in adults, however, currently there is a lack of consensus among experts as to whether this combined treatment approach is more effective than if either treatment modality is used alone.

The cornerstone of drug therapy for obsessive-compulsive disorder (OCD) is medications that inhibit the reuptake of serotonin - a neurotransmitter (chemical messenger) in the brain that is involved in regulating mood, behavior, and thought. People who experience depression, mood swings, or anxiety disorders often have a deficiency of serotonin. Medications called serotonin reuptake inhibitors often help people feel better by boosting the levels of serotonin. Medications that may be used for the treatment of OCD include the tricyclic antidepressant clomipramine (Anafranil) and medications that belong to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). Examples of SSRI's that may be used for the treatment of OCD include:

• Fluvoxamine (Luvox)
• Paroxetine (Paxil; Paxil CR)
• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Citalopram (Celexa)

Clinical studies with serotonin reuptake inhibitors for the treatment of obsessive-compulsive disorder (OCD) have shown that:

• Approximately 50% of patients with OCD experience and improvement in symptoms.
• Usually it takes about 2-3 months of drug therapy to notice an improvement in OCD symptoms.
• Significantly higher doses of a serotonin reuptake inhibitor are required to treat people with OCD than to treat people with depression.
• Patients with OCD may respond to one medication better than to another so that it may take several trials of testing various serotonin reuptake inhibitors before the most effective drug is identified.
• Patients who discontinue their medication will usually experience a relapse of their OCD symptoms.
• Patients with OCD who fail to respond to serotonin reuptake inhibitors may be treated with second-line medications that include clonazepam (Klonopin) and buspirone (BuSpar), among others.