Skip to main content
SpringerLink
Log in

Current Concepts in the Pharmacological Treatment of Obsessive-Compulsive Disorder

  • Practical Therapeutic
  • Published:
Drugs Aims and scope Submit manuscript

Summary

Obsessive-compulsive disorder (OCD) is a chronic and often disabling disease. OCD is characterised by intrusive, unwanted and persistently recurring mental events (obsessions) that usually evoke discomfort or anxiety, and/or repetitive ritualistic behaviours (compulsions) that are aimed at reducing discomfort and anxiety. However, the compulsions succeed only in achieving transient relief, followed by a growing sense of pressure.

10 years ago, OCD was considered a rare and treatment-refractory disorder. Recent well de-signed studies document a lifetime prevalence rate for OCD of more than 2% in the general population. The outlook for patients with OCD has changed in the last decade, with many well controlled studies showing that OCD patients respond to specific behavioural and pharmacological treatments.

The specific form of behavioural therapy is in vivo exposure coupled with response prevention. Only serotonin reuptake inhibitors, such as clomipramine, fluoxetine and fluvoxamine, are effective in the treatment of both depressed and not depressed OCD patients. Fluoxetine and fluvoxamine lack the anticholinergic side effects of clomipramine and, thus, provide an alternative treatment for patients who cannot tolerate clomipramine. Other nonserotonergic antidepressants (tricyclics and monoamine oxidase inhibitors) and anxiolytic agents have not been found to be consistently effective in this disorder. Insufficient data on the efficacy of neuroleptics and their potentially irreversible side effects limit their use in OCD patients.

Behavioural and the pharmacological treatment are complementary, and a combination of the 2 therapies is apparently more effective than either modality alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Akhtar S, Wig NH, Verma VK, Pershad L. A phenomenological analysis of symptoms in obsessive compulsive disorder. British Journal of Psychiatry 127: 342–348, 1975

    Article  PubMed  CAS  Google Scholar 

  • Ananth J. Treatment of obsessive compulsive neurosis: pharmacological approach. Psychosomatics 17: 180–184, 1976

    PubMed  CAS  Google Scholar 

  • Ananth J, Pecknold JC, van dar Steen N, Engelsman F. Double blind comparative study of clomipramine and amitriptyline in obsessive neurosis. Progress in Neuro-Psychopharmology and Biological Psychiatry 5: 257–264, 1981

    CAS  Google Scholar 

  • Ananth J, Solyom L, Btyntwick S, Krishnappa U. Chlorimipramine therapy for obsessive-compulsive neurosis. American Journal of Psychiatry 136: 700–701, 1979

    PubMed  CAS  Google Scholar 

  • Baxter Jr LR, Phelps ME, Mazziotta JC, Guze BH, Schwartz JM, et al. Local cerebral glucose metabolic rates in obsessive compulsive disorder: a comparison with rates in unipolar depression and normal controls. Archives of General Psychiatry 44: 208–211, 1987

    Article  Google Scholar 

  • Benfield P, Heel RC, Lewis SP. Fluoxetine. A review of its pharmacodynamics and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs 32: 481–508, 1986

    Article  PubMed  CAS  Google Scholar 

  • Benfield P, Ward A. Fluvoxamine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs 32: 313–334, 1986

    Article  PubMed  CAS  Google Scholar 

  • Bland RC, Newman SC, Orn H. Lifetime prevalence of psychiatric disorders in Edmonton. Acta Psychiatrica Scandinavica 77 (Suppl. 338): 24–32, 1988a

    Article  Google Scholar 

  • Bland RC, Newman SC, Orn H. Period prevalence of psychiatric in Edmonton. Acta Psychiatrica Scandinavica 77 (Suppl. 338): 33–42, 1988b

    Article  Google Scholar 

  • Bodkin JA, White K. Clonazepam in the treatment of obsessive-compulsive disorder associated with panic disorder in one patient. Journal of Clinical Psychiatry 50: 265–266, 1989

    PubMed  CAS  Google Scholar 

  • DeVeaugh Geiss J, Landan P, Katz R. Treatment of obsessive-compulsive disorder with clomipramine. Psychiatric Annals 19: 97–101, 1989

    Google Scholar 

  • Eisenberg J, Asnis G. Lithium as an adjunct treatment in obsessive-compulsive disorder. American Journal of Psychiatry 142: 663, 1986

    Google Scholar 

  • Fernandez de Cordoba CE, Lopez-Ivor JJ. Monochlorimipramine in the treatment of psychiatric patients resistant to other therapies. Act Luso-Esp Neurolo 26: 111–147, 1967

    Google Scholar 

  • Flament MF, Rapoport JL, Berg CJ, Sceery W, Kilts C, et al. Clomipramine treatment of childhood obsessive compulsive disorder: a double-blind controlled study. Archives of General Psychiatry 42: 977–983, 1985

    Article  PubMed  CAS  Google Scholar 

  • Foa EB, Steketee G, Kozak MJ, Dugger D. Effects of imipramine on depression and obsessive-compulsive symptoms. Psychiatry Research 21: 123–136, 1987

    Article  PubMed  CAS  Google Scholar 

  • Fontaine R, Chourinard G. An open clinical trial of fluoxetine in the treatment of obsessive-compulsive disorder. Journal of Clinical Psychopharmacology 2: 98–101, 1986

    Google Scholar 

  • Goodman WK, Price LH, Delgado PL, et al. Specificity of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder. Archives of General Psychiatry 47: 577–585, 1990

    Article  PubMed  CAS  Google Scholar 

  • Goodman WK, Price LH, Rasmussen SA, et al. Efficacy of fluvoxamine in obsessive-compulsive disorder: a double-blind comparison of fluvoxamine and placebo. Archives of General Psychiatry 46: 36–40, 1989

    Article  PubMed  CAS  Google Scholar 

  • Goodwin D, Guze S, Robins E. Follow-up studies in obsessional neurosis. Archives of General Psychiatry 20: 182–187, 1969

    Article  PubMed  CAS  Google Scholar 

  • Guttmacher LB, Zohar J, Insel TR. Electroconvulsive therapy for patients with obsessive-compulsive disorder (submitted). Hussain MZ, Ahad A. Treatment of obsessive compulsive neurosis. Canadian Medical Association Journal: 103–648, 1970

  • Insel TR (Ed.) New findings in obsessive-compulsive disorder. American Psychiatric Press, Washington D.C., 1984

    Google Scholar 

  • Insel TR, Alterman I, Murphy DL. Anti-obsessional and antidepressant effects of clomipramine in the treatment of obsessive-compulsive disorder. Psychopharmacology Bulletin 18: 115–117, 1982

    PubMed  CAS  Google Scholar 

  • Insel TR, Mueller EA, Gillin JC, Siever LJ, Murphy DC. Tricyclic response in obsessive compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 9: 25–31, 1985

    Article  PubMed  CAS  Google Scholar 

  • Insel TR, Murphy DL, Cohen RM, Alterman I, Linnoila M, et al. Obsessive-compulsive disorder: a double-blind trial of clomipramine and clorgyline. Archives of General Psychiatry 40: 605–612, 1983

    Article  PubMed  CAS  Google Scholar 

  • Jain VK, Swinson RP, Thomas JE. Phenelzine in obsessional neurosis. British Journal of Psychiatry 127: 237–238, 1970

    Google Scholar 

  • Jenike MA. Rapid response of severe obsessive-compulsive disorder to tranylcypromine. American Journal of Psychiatry 138: 1249–1250, 1981

    PubMed  CAS  Google Scholar 

  • Jenike MA, Bulttoph L, Baer L, et al. Open trial of fluoxetine in obsessive compulsive disorder. American Journal of Psychiatry 146: 909–911, 1989

    PubMed  CAS  Google Scholar 

  • Jenike MA, Hyman S, Baer L, et al. A controlled trial of fluvoxamine in obsessive-compulsive disorder: implications for a serotonergic theory. American Journal of Psychiatry 147: 1209–1215, 1990

    PubMed  CAS  Google Scholar 

  • Kalinowsky LB, Hippius H. Pharmacological, convulsive and other somatic treatments in psychiatry, Grune and Stratton, New York, 1969

  • Karno M, Goldin JM, Sorenson SB, Burnom A, et al. The epidiology of obsessive-compulsive disorder in five US communities. Archives of General Psychiatry 45: 1094–1099, 1988

    Article  PubMed  CAS  Google Scholar 

  • Kelly D. Anxiety and Emotions. Charles C Thomas, Publisher, Springfield, 1980

    Google Scholar 

  • Knesevich JW. Successful treatment of obsessive compulsive disorder with clinidine hydrochloride. American Journal of Psychiatry 139: 364–365, 1982

    PubMed  CAS  Google Scholar 

  • Leonard HL, Swedo SE, Rapoport JL, et al. Treatment of childhood obsessive compulsive disorder with clorimipramine and desipramine: a double blind crossover comparison. Psychopharmacology Bulletin 24: 93–95, 1988

    PubMed  CAS  Google Scholar 

  • Lewin W. Observations on selective leucotomy. Journal of Neurology, Neurosurgery and Psychiatry 24: 37–44, 1961

    Article  CAS  Google Scholar 

  • Loucas KP, Stafford-Clark D. Electronarcosis at Guy’s. Guy Hospital Report 114: 223–237, 1965

    CAS  Google Scholar 

  • Marks IM. Review of behavioural psychotherapy. I. Obsessive-compulsive disorder. American Journal of Psychiatry 138(5): 584–592, 1981

    PubMed  CAS  Google Scholar 

  • Marks IM, Stern R, Mawson D, Cobb J, McDonald R. Clomipramine and exposure for obsessive-compulsive rituals. British Journal of Psychiatry 136: 1–25, 1980

    Article  PubMed  CAS  Google Scholar 

  • Mavissakalian M, Turner S, Michelson L, Jacob R. Tricyclic antidepressants in obsessive-compulsive disorder: antiobsessional or antidepressant agents? American Journal of Psychiatry 142: 572–576, 1985

    PubMed  CAS  Google Scholar 

  • McDougle CJ, Goodman WK, Price LH, et al. Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. American Journal of Psychiatry 147: 652–654, 1990

    PubMed  CAS  Google Scholar 

  • McTavish D, Benfield P. Clomipramine. An overview of its pharmacological properties and a review of its therapeutic use in obsessive compulsive disorder and panic disorder. Drugs 39: 136–153, 1990

    Article  PubMed  CAS  Google Scholar 

  • Mellman LA, Gorman JM. Successful treatment of obsessive-compulsive disorder with ECT. American Journal of Psychiatry 141: 596–594, 1984

    PubMed  CAS  Google Scholar 

  • Mitchell-Heggs N, Kelly D, Richardson A. Stereotactic limbic leucotomy: a follow up at 16 months. British Journal of Psychiatry 128: 226–2240, 1976

    Article  PubMed  CAS  Google Scholar 

  • Montgomery SA. Clomipramine in obsessional neurosis: a placebo controlled trial. Pharmaceutical Medicine 1 189–192, 1980

    Google Scholar 

  • Murphy DL, Siever LJ, Insel TR. Therapeutic responses to tricyclic antidepressants and related drugs in no-affective disorder patient population. Progress in Neuro-Psychopharmacology and Biological Psychiatry 9: 3–13, 1985

    Article  PubMed  CAS  Google Scholar 

  • Nemiah JC. Forward In Insel TR (Ed.) New findings in obsessive compulsive disorder pp. 9–11, American Psychiatric Press, Washington D.C., 1984

    Google Scholar 

  • O’Regan JB. Treatment of obsessive compulsive neurosis with haloperidol. Canadian Medical Association Journal 103: 167–168, 1970

    PubMed  Google Scholar 

  • Pato PT, Zohar-Kadouch RC, Zohar J, Murphy DL. Return of symptoms after discontinuation of clorimipramine in patients with obsessive compulsive disorder. American Journal of Psychiatry 145: 1521–1525, 1988

    PubMed  CAS  Google Scholar 

  • Perse TL, Greist JH, Jefferson RH, Rosenfeld R, Dar R. Fluvoxamine treatment of obsessive-compulsive disorder. American Journal of Psychiatry 144: 1543–1548, 1988

    Google Scholar 

  • Pigott TA, Pato MT, Bernstein SE, Grover GN, Hill JL, et al. Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder: behavioral and biological results. Archives of General Psychiatry 47: 926–932, 1990

    Article  PubMed  CAS  Google Scholar 

  • Post F, Rees WL, Schurr PH. An evaluation of bimedial leucotomy. British Journal of Psychiatry 114: 1223–1246, 1968

    Article  PubMed  CAS  Google Scholar 

  • Prasad AJ. Obsessive-compulsive disorder and trazodone. American Journal of Psychiatry 141: 6123–613, 1984

    Google Scholar 

  • Price LH, Goodman WK, Charney DS, Rasmussen SA, Heninger GR. Treatment of severe obsessive-compulsive disorder with fluvoxamine. American Journal of Psychiatry 144: 1059–1061, 1987

    PubMed  CAS  Google Scholar 

  • Rachman SJ. Primary obsessional slowness. Behavioral Research and Therapy 11: 463–471, 1974

    Article  Google Scholar 

  • Rachman SJ, Hodgson RJ. Obsessions and compulsions: the concept. In Rachman SJ, Hodgson RJ (Eds) Obsessions and compulsions, pp. 9–21, Prentice-Hall, New Jersey, 1980a

    Google Scholar 

  • Rachman SJ, Hodgson RJ. Conventional treatment and prognosis. In Rachman SJ, Hodgson RJ (Eds) Obsessions and compulsions, pp. 97–105, Prentice-Hall, New Jersey, 1980b

    Google Scholar 

  • Rack PH. Clinical experience in the treatment of obessional states. Journal of International Medical Research 5: 81–96, 1977

    PubMed  Google Scholar 

  • Rasmussen SA. Lithium and tryptophan augmentation in clomipramine resistant obsessive-compulsive disorder. American Journal of Psychiatry 141: 1283–1285, 1984

    PubMed  CAS  Google Scholar 

  • Rasmussen SA. Obsessive-compulsive disorder in dermatologic practice. Journal of the American Academy of Dermatology 13: 965–967, 1985

    Article  PubMed  CAS  Google Scholar 

  • Robins LN, Heizer HE, Weissman MM, Orvaschel H, Gruenberg E, et al. Lifetime prevalence of specific psychiatric disorders in three communities. Archives of General Psychiatry 41: 949–967, 1984

    Article  PubMed  CAS  Google Scholar 

  • Roth M. Physical methods of treatment in mental disease. Practitioner 194: 613–620, 1965

    Google Scholar 

  • Sargant W, Slater E. Proceedings of the Royal Society of Medicine 43: 1007–1010, 1950

    Google Scholar 

  • Smith B, Kilom LF, Cochrane N, et al. A prospective evaluation of open prefrontal leucotomy. Medical Journal of Australia 1: 731–735, 1976

    PubMed  CAS  Google Scholar 

  • Steketee G, Foa E, Grayson J. Recent advances in the behavioral treatment of obsessive compulsives. Archives of General Psychiatry 39: 1365–1371, 1982

    Article  PubMed  CAS  Google Scholar 

  • Stern TA, Jenike MA. Treatment of obsessive-compulsive disorder with lithium carbonate. Psychosomatics 24: 673–674, 1983

    Google Scholar 

  • Strom-Olsen R, Carlisle B. Frontal stereotactic tractotomy: a follow up study of its effects on 210 patients. British Journal of Psychiatry 118: 141–154, 1971

    Article  PubMed  CAS  Google Scholar 

  • Tesar GE, Jenike MA. Alprazolam as treatment for a case of obsessive-compulsive disorder. American Journal of Psychiatry 141: 689–690, 1984

    PubMed  CAS  Google Scholar 

  • Thoren P, Asberg M, Bertilsson L, Mellstrom B, Sjowvist F, et al. Clomipramine treatment of obsessive-compulsive disorder. II. Biochemical aspects. Archives of General Psychiatry 37: 1289–1294, 1980b

    Article  PubMed  CAS  Google Scholar 

  • Thoren P, Asberg M, Gronholm B, Jornestedt L, Traskman L. Clomipramine treatment of obsessive-compulsive disorder. I. A controlled clinical trial. Archives of General Psychiatry 37: 1281–1285, 1980a

    Article  PubMed  CAS  Google Scholar 

  • Tippin J, Henn FA. Modified leucotomy in the treatment of intractable obsessional neurosis. American Journal of Psychiatry 139: 1601–1603, 1982

    PubMed  CAS  Google Scholar 

  • Tollefson G. Alprazolam in the treatment of obsessive symptoms. Journal of Clinical Psychopharmacology 5: 39–42, 1985

    PubMed  CAS  Google Scholar 

  • Turner SM, Jacob RG, Beidel DC, Himmelhoch J. Fluoxetine treatment of obsessive-compulsive disorder. Journal of Clinical Psychopharmacology 5(4): 207–212, 1985

    Article  PubMed  CAS  Google Scholar 

  • Volavka J, Neziroglu F, Yaryura-Tobias JA. Clomipramine and imipramine in obsessive-compulsive disorder. Psychiatry Research 14: 83–91, 1985

    Article  Google Scholar 

  • Welner A, Reich T, Robins E. Obsessive compulsive neurosis: record, follow-up and family studies. I. Inpatient record study. Comprehensive Psychiatry 17: 527–539, 1976

    Article  PubMed  CAS  Google Scholar 

  • Woodruff R, Pitts Jr FN. Monozygotic twins with obsessional illness. American Journal of Psychiatry 120: 1075–1080, 1964

    PubMed  CAS  Google Scholar 

  • Yaruyra-Tobias JA, Bhagavan HN. L-tryptophan in obsessive-compulsive disorder. American Journal of Psychiatry 234: 1298–1299, 1977

    Google Scholar 

  • Zohar J, Insel TR. Obsessive compulsive disorder: psychobiological approach to diagnosis, treatment and psychobiology. Biological Psychiatry 22: 667–687, 1987

    Article  PubMed  CAS  Google Scholar 

  • Zohar J, Mueller EA, Zohar-Kadouch RC, Inset RT, Murphy DL. Serotonergic responsitivity in obsessive-compulsive disorder, comparison of patients and healthy controls. Archives of General Psychiatry 44: 946–951, 1987

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Anxiety Clinic, Chaim-Sheba Medical Center, Tel Hashomer, 52621, Israel

    Joseph Zohar, Rachel C. Zohar-Kadouch & Seth Kindler

Authors
  1. Joseph Zohar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rachel C. Zohar-Kadouch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seth Kindler
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zohar, J., Zohar-Kadouch, R.C. & Kindler, S. Current Concepts in the Pharmacological Treatment of Obsessive-Compulsive Disorder. Drugs 43, 210–218 (1992). https://doi.org/10.2165/00003495-199243020-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199243020-00007

Keywords

Search

Navigation