Management of Patients With Obsessive-Compulsive Disorder: Focus on Pharmacotherapy

Abstract

The use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of obsessive-compulsive disorder (OCD) has dramatically changed clinical practice. Indeed, SSRIs are currently considered the first-line pharmacological therapy for OCD. However, randomized controlled trials (RCTs) have demonstrated a limited efficacy of SSRI treatment in OCD, with nearly half of patients experiencing an unsatisfactory outcome. Critically, nonresponse to treatment of OCD is associated with significant morbidity and social disability. In this study, we conducted a narrative review of the literature to describe and reinforce the basic rationale for pharmacological treatment of OCD. Our primary aim is to discuss the most common clinical issues that arise during the treatment of patients with OCD—details that have not been fully covered within the reports of RCTs. To this end, based on the knowledge of clinicians experienced in OCD treatment, here we provide the best evidence regarding pharmacotherapy for OCD and the management of potential clinical situations that may arise therein. The topics explored in this article include the first- and second-line pharmacological treatments for OCD, concepts of response and remission, pharmacological strategies for SSRI-resistant OCD, and management of adverse events. [ Psychiatr Ann . 2022;52(4):143–151.]