Current issues in the pharmacologic management of obsessive compulsive disorder

It has been conclusively demonstrated that the SRIs are effective in the treatment of OCD. Although the neuroleptics and anxiolytics may be effective as augmenting agents for some patients, there can be no question that the SRIs are the drug of first choice. There are no convincing data to suggest that significant differences in efficacy exist between SRIs. Most patients are willing to tolerate the acute side effects to obtain benefit from the drugs. Sedation, sexual dysfunction, and weight gain are the most problematic side effects encountered in maintenance treatment. Patients should be treated for 10 to 12 weeks before they are considered treatment resistant. Responders should be maintained for at least 1 year before drug treatment is discontinued. An integrated approach to treatment that combines pharmacologic, behavioral, and psychosocial approaches to treatment leads to the best long-term outcome.