Summary
OCD has been viewed traditionally as resistant to conventional therapies. Fortunately, in recent years there have been advances in both the pharmacotherapy and behavioral therapy of OCD. For example, more than 50% of patients treated with potent serotonin reuptake inhibitors (SRIs) such as clomipramine (CMI) or fluvoxamine (FVX) are judged by blind raters as “much” or “very much” improved. The magnitude of improvement in these “responders” represents about a 40% decrease in obsessive-compulsive symptom severity, as reflected on the Yale-Brown Obsessive Compulsive Scale. On the other hand, OCD patients treated with norepinephrine reuptake inhibitors (e.g. desipramine) generally show no change. This contrasts sharply with the results of controlled trials in depression, in which drugs with very different profiles of monoamine reuptake inhibition are roughly equivalent in antidepressant efficacy.
Studies of the efficacy and tolerability of SRIs in OCD will be reviewed with the goal of providing practical guidelines to the use of these medications in OCD. The use of “antidepressants” in the treatment of depression vs the treatment of OCD will be compared. Until large-scale studies have been conducted in which the anti-OC efficacy of the different potent SRIs can be compared directly, the initial choice of a medication treatment for an individual OCD patient may be based mostly on its sideeffects profile and availability. The implications of these treatment response data for the pathophysiology of OCD will also be discussed briefly.
Zusammenfassung
Die Zwangsstörung ist lange Jahre als therapieresistent angesehen worden. Glücklicherweise hat es in den letzten Jahren aber Fortschritte sowohl in der Pharmakotherapie als auch der Verhaltenstherapie von OCD gegeben. So werden z.B. mehr als 50% der Patienten, die mit wirksamen Serotonin-Reuptake-Hemmern (SRIs) wie Clomipramin (CMI) oder Fluvoxamin (FVX) behandelt wurden, durch Fremdrating als „deutlich“ oder „sehr deutlich gebessert“ bewertet. Andererseits zeigen OCD-Patienten, die mit Norepinephrin-Reuptake-Hemmern (z.B. Desipramin) behandelt werden, i.allg. keine Besserung. Dieses Ergebnis kontrastiert deutlich mit den Ergebnissen kontrollierter Studien bei Depression, in denen Arzneimittel mit sehr unterschiedlichen Strukturen der Monoamino-Reuptake-Hemmung alle ungefähr gleich wirksam hinsichtlich ihrer antidepressiven Wirkung sind. Studien zur Wirkung und Verträglichkeit von SRIs bei OCD werden mit dem Ziel dargestellt, praktische Anwendungsrichtlinien daraus abzuleiten. Die Anwendung von „Antidepressiva“ bei der Behandlung von Depression bzw. OCD wird miteinander verglichen. Bevor nicht, nach Durchführung zahlenmäßig großer Studien, die unterschiedliche Wirksamkeit von Serotonin-Reuptake-Hemmern direkt verglichen werden kann, wird die anfängliche Entscheidung für eine Pharmakotherapie für den OCD-Patienten im Einzelfall auf der Beurteilung des Nebenwirkungsprofils und der Verfügbarkeit basieren müssen. Die Implikationen der Daten der Responder auf diese Behandlung für die Pathophysiologie von OCD wird kurz diskutiert.
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© 1992 Springer-Verlag Berlin Heidelberg
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Goodman, W.K. (1992). Pharmacotherapy of Obsessive-Compulsive Disorder. In: Hand, I., Goodman, W.K., Evers, U. (eds) Zwangsstörungen / Obsessive-Compulsive Disorders. Die Reihe dupbar med communication wird / Series dupbar med communication. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77608-3_13
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