Long-term management of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a chronic debilitating condition that requires long-term treatment. The selective serotonin reuptake inhibitors (SSRIs) appear to be associated with similar levels of efficacy to clomipramine in short-term treatment, but to have significant tolerability advantages. The results of the long-term controlled studies on clomipramine, fluvoxamine, fluoxetine and sertraline are reviewed. They demonstrate a significantly better outcome for anti-obsessional drugs than placebo. The absence of adequate long-term controlled studies on pharmacotherapy strengthen the grounds for recommending pharmacotherapy as the optimal approach for long-term treatment of OCD. The SSRIs would appear to be the treatment of choice in OCD in view of their tolerability and safety advantages compared with clomipramine.