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Drug Treatment for OCD

Until the advent of SSRIs, the Drug Treatment of choice for obsessive-compulsive disorder, OCD, was clomipramine, a tricyclic. This has been shown to be effective in the treatment of obsessive-compulsive disorder independent of any effect on mood. The Clomipramine Collaborative Study Group (1991), for example, reported an average 40 per cent reduction in symptoms, in comparison with 5 per cent achieved by placebo. Where the effectiveness of clomipramine and SSRIs has been directly assessed, both treatments seem to be equally effective, and to have similar levels of side-effects (Bandelow 2008). Unfortunately, many people relapse after discontinuing treatment, and it may take many months before a maximum response is achieved. Pato et al. (1988), for example, reported that 16 out of 18 people treated with clomipramine relapsed within seven weeks of not taking the drug, despite some of them having been on the drug for over a year. In the strongest comparative study of the effi cacy of drugs and exposure plus response prevention, Foa et al. (2005) compared the effects of clomipramine with an exposure and response prevention, a combination of both, and a pill placebo. By the end of therapy, all the active treatments proved superior to the placebo intervention. The least effective intervention was the clomipramine. The most effective intervention was exposure plus response prevention – which had no additional benefi t from being combined with clomipramine.

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