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Pharmacological Management of Treatment-Resistant Obsessive-Compulsive Disorder

  • Therapy in Practice
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Abstract

Once considered rare and resistant to treatment, obsessive-compulsive disorder (OCD) has now emerged as a common, yet often unrecognized, psychiatric condition. Treatment with selective serotonin reuptake inhibitors (SSRIs) is effective in 40–60% of patients with OCD. Management of the remaining 40–60% of patients with treatment-resistant OCD is challenging.

We review up-to-date evidence focusing on strategies for treatment-resistant OCD, including increasing the dose of SSRI, switching to another SSRI, augmentation with antipsychotics, and the use of serotonin nor-adrenaline (norepinephrine) reuptake inhibitors (SNRIs) and monoamine oxidase inhibitors (MAOIs). Finally, we provide a flow chart, which includes nonpharmacological interventions such as cognitive-behavioural therapy, family interventions and physical interventions such as neurosurgery and deep brain stimulation, alongside the pharmacological strategies.

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Acknowledgements

No financial support was received to prepare this article. Prof. Zohar has received consultancy fees, research funding and honoraria from Lundbeck, Servier, Pfizer and Solvay. Dr Abudy and Dr Juven-Wetzler have no conflicts of interest that are relevant to the content of this article. The authors wish to thank Rachel Sonnino for her assistance in the preparation of this article.

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  1. Department of Psychiatry, Chaim Sheba Medical Center, 2, Ramat Gan, 52621, Tel Hashomer, Israel

    Anat Abudy, Alzbeta Juven-Wetzler &  Joseph Zohar

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  1. Anat Abudy
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Correspondence to Joseph Zohar.

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Abudy, A., Juven-Wetzler, A. & Zohar, J. Pharmacological Management of Treatment-Resistant Obsessive-Compulsive Disorder. CNS Drugs 25, 585–596 (2011). https://doi.org/10.2165/11587860-000000000-00000

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