Obsessive-compulsive disorder pharmacological treatment

Thomsen, P.H. (2000) Obsessive-compulsive disorder pharmacological treatment. Eur Child Adolesc Psychiatry 9 76-84. 

Pathophysiological basis of panic disorder and obsessive-compulsive disorder pharmacological treatment... 

Doxepin [1668-19-5] (38), unlike other commercially available tricyclics, has an oxygen atom in the bridge between the two aromatic rings. It is marketed as a cis—trans mixture (1 5) of isomers, both of which are active. This close relative of amitriptyline (33) has both sedative and anxiolytic properties associated with its antidepressant profile. Maprotiline [10262-69-8] (39) and amoxapine [14028-44-5] (40) are pharmacologically, although not chemically, similar to the tricycHc secondary amines. Clomipramine [303-49-1] (41) has similar pharmacological and antidepressant efficacy. However, clomipramine is approved by the U.S. FDA only for the treatment of obsessive—compulsive disorder. Representative brands of tricycHc antidepressants marketed in the United States are Hsted in Table 2. 

A considerable number of tricyclic antidepressants have been developed in the past, although with slight differences in their pharmacological activities, ah with similar efficacy. They are primarily indicated for the treatment of endogenous depression. However this does not exclude efficacy in patients in whom the depression is associated with organic disease or in patients with reactive depression or depression combined with anxiety. They may also benefit patients during the depressive phase of manic-depressive disorder. For some also efficacy has been claimed in panic states, phobic disorders, and in obsessive-compulsive disorders. 

Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ, Henk HJ (1998) Behavioral versus pharmacological treatments of obsessive compulsive disorder a meta-analysis. Psychopharmacology (Berl) 136 205-216... 

Clomipramine (Anafranil) also a member of the tricyclic family, possesses similar pharmacology and antidepressant efficacy. This agent, however, has Food and Drug (FDA) approval only for use in the treatment of obsessive-compulsive disorder and is not included in this discussion of antidepressant drugs. 

TABLE 39.2 Pharmacological Treatment Studies in Pediatric Obsessive-Compulsive Disorder... 

One of the clinician s most important tasks is thus to identify the principal sources of distress and impairment and to prioritize the targets for pharmacological intervention. Although tic reduction may be the first priority in some cases, in other cases it may be a child s ADHD, depression, or compulsions that may have the first claim on the clinician s interventional efforts. Even when the tics are not themselves the initial target of treatment, the TS-related nature of the child s depression, ADHD, or obsessive-compulsive disorder (OCD) may have important implications for the choice of agents, therapeutic response, or possible side effects. 

Joffe RT, Swinson RP Total sleep deprivation in patients with obsessive-compulsive disorder. Acta Psychiatr Scand 77 483-487, 1988 Joffe RT, Swinson RP, Levitt AJ Acute psychostimulant challenge in primary obsessive-compulsive disorder. J Chn Psychopharmacol 11 237-241, 1991 Johns CA, Greenwald BS, Mohs RC, et al The chohnergic treatment strategy in aging and senile dementia. Pharmacological Bulletin 19 185-197, 1983 Johnson BB, Naylor GJ, Dick EG, et al Prediction of chnical course of bipolar manic depressive illness treated with hthium. Psychol Med 10 329-334, 1980... 

Montgomery SA Pharmacological treatment of obsessive compulsive disorder, in Current Insights in Obsessive Compulsive Disorder. Edited by Hollander E, Zohar A, Marazziti D, et al. Chichester, England, Wiley, 1994, pp 215-225... 

Stanley MA, Turner SM Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behav Ther 26 162-186, 1995... 

Fontenelle LF et al An update on the pharmacological treatment of obsessive-compulsive disorder. Expert Opin Pharmacother 2007 8(5) 563. [PMID 17376013]... 

Foa EB, Steketee GS, Ozarow BJ (1985) Behaviour therapy with obsessive compulsives from therapy to treatment. In M Mavissakalian, SM Turner, L Michelsen (eds) Obsessive compulsive disorder psychological and pharmacological treatments. Plenum Press, New York... 

It is important to screen patients for co-occurring mental disorders, and their presence may become more apparent during the stabilization or maintenance phases of schizophrenia treatment. Examples include substance abuse disorders, depression, obsessive-compulsive disorder, and panic disorder. As co-occurring disorders will limit symptom and functional improvement and increase the risk of relapse, it is critical that they be appropriately treated. Pharmacological and nonpharmacological interventions specific for the co-occurring disorder should be implemented in combination with evidence-based treatment for schizophrenia. 

Hament ME, Bisserbe JC. Pharmacologic treatment of obsessive-compulsive disorder Comparative studies. J Clin Psychiatry 1997 58(Suppl 12) 18-22. 

SSRIs are agents of choice in obsessive-compulsive disorder and in the syndromes of impulse dyscontrol or obsessive preoccupations (e.g., compulsive gambling, trichotillomania, bulimia, but usually not anorexia nervosa and body dysmorphic disorder). Despite their hmited benefits, SSRIs offer an important advance in the medical treatment of these often chronic and sometimes incapacitating disorders. The effectiveness of pharmacological treatment for these disorders is greatly enhanced by use of behavioral treatments. 

Inhibition of serotonin reuptake from the neuronal synapse and the subsequent increase in its functionality is one of the mainstays of the pharmacological treatment of depression. Like many amino acids, tryptophan is commercially available as a nutritional supplement or as a so-called smart drug, claiming to reduce symptoms of depression, anxiety, obsessive-compulsive disorders, insomnia, fibromyalgia, alcohol withdrawal, and migraine. However, no convincing clinical data are available to support these... 

In 1987, the United States Food and Dmg Administration (FDA) approved the use of fluoxetine for the treatment of depression and this derivative is now considered to be the prototype of a dmg class called selective serotonin reuptake inhibitors (SSRIs). As the name suggests, this term refers to the reuptake blockage of serotonin into the pre-synaptic membrane in order to indirectly increase neurotransmitter availability. A number of these derivatives showed beneficial effects for the treatment of a variety of additional conditions such as obsessive-compulsive disorders (OCD), bulimia nervosa, anxiety disorders, obesity, anorexia, post-traumatic stress disorders (PTSD) and others. SSRIs have become the first-line therapy for depression, which is based on improved side effect profiles when compared with TCA derivatives or MAOIs. A number of adverse effects are described in the pharmacological literature and include sexual dysfunction. 

Bandelow B, Zohar J, Hollander E, et al. Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders. World J Biol Psychiatry 2002 3 171-199. 

Data from Katon WJ. Panic disorder. N Engl J Med 2006 354 2360-2367 Bandelow B, Zohar J, Hollander E, etal. Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 2002,3 171-199 Work Group on Panic Disorder. Practice guideline for the treatment of patients with panic disorder. Am J Psychiatry 1998 155(Supp 5) l-34 and EffexorXR[package insert]. Philadelphia, PA Wyeth Pharmaceuticals, Inc., August 2006. 

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