Obsessive-compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults

Naomi A Fineberg; Samar Reghunandanan; Helen B Simpson; Katharine A Phillips; Margaret A Richter; Keith Matthews; Dan J Stein; Jitender Sareen; Angus Brown; Debbie Sookman; Accreditation Task Force of The Canadian Institute for Obsessive Compulsive Disorders

doi:10.1016/j.psychres.2014.12.003

Obsessive-compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults

Psychiatry Res. 2015 May 30;227(1):114-25. doi: 10.1016/j.psychres.2014.12.003. Epub 2015 Feb 11.

Affiliations

¹ Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House,Parkway ,Welwyn Garden City, Hertfordshire, AL8 6HG, UK; Postgraduate Medical School, University of Hertfordshire, College Lane, Hatfield, UK; University of Cambridge School of Clinical Medicine, Addenbrooke׳s Hospital, Box 189, Cambridge CB2 2QQ, UK. Electronic address: naomi.fineberg@hpft.nhs.uk.
² Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House,Parkway ,Welwyn Garden City, Hertfordshire, AL8 6HG, UK.
³ College of Physicians and Surgeons at Columbia University, New York, NY, USA; Anxiety Disorders Clinic and the Centre for OCD and Related Disorders at the New York State Psychiatric Institute, New York, NY, USA.
⁴ Rhode Island Hospital and the Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
⁵ Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
⁶ Division of Neuroscience, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
⁷ Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
⁸ Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁹ Obsessive Compulsive Disorder Clinic, Department of Psychology, McGill University Health Centre, and Department of Psychiatry, McGill University, Montreal, PQ, Canada.

PMID: 25681005
DOI: 10.1016/j.psychres.2014.12.003

Abstract

This narrative review gathers together a range of international experts to critically appraise the existing trial-based evidence relating to the efficacy and tolerability of pharmacotherapy for obsessive compulsive disorder in adults. We discuss the diagnostic evaluation and clinical characteristics followed by treatment options suitable for the clinician working from primary through to specialist psychiatric care. Robust data supports the effectiveness of treatment with selective serotonin reuptake inhibitors (SSRIs) and clomipramine in the short-term and the longer-term treatment and for relapse prevention. Owing to better tolerability, SSRIs are acknowledged as the first-line pharmacological treatment of choice. For those patients for whom first line treatments have been ineffective, evidence supports the use of adjunctive antipsychotic medication, and some evidence supports the use of high-dose SSRIs. Novel compounds are also the subject of active investigation. Neurosurgical treatments, including ablative lesion neurosurgery and deep brain stimulation, are reserved for severely symptomatic individuals who have not experienced sustained response to both pharmacological and cognitive behavior therapies.

Keywords: Compulsive; Obsessive; Pharmacotherapy.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Antipsychotic Agents / therapeutic use*
Clomipramine / therapeutic use*
Cognitive Behavioral Therapy*
Combined Modality Therapy
Deep Brain Stimulation*
Humans
Obsessive-Compulsive Disorder / drug therapy
Obsessive-Compulsive Disorder / psychology
Obsessive-Compulsive Disorder / therapy*
Selective Serotonin Reuptake Inhibitors / therapeutic use

Substances

Antipsychotic Agents
Serotonin Uptake Inhibitors
Clomipramine