Treatment of obsessive-compulsive disorder
Most experts believe that the best effect is achieved with a combination of psychotherapy and medication, especially in severe cases. Effective SSRIs and clomipramine (tricyclic antidepressant with a pronounced serotonergic effect). For most SSRIs, low doses (eg, fluoxetine 20 mg / day once, fluvoxamine 100 mg / day once, sertraline 50 mg / day once, paroxetine 40 mg / day once) are usually also effective, as are high doses.
In the past, obsessive-compulsive disorder was considered a condition resistant to treatment. Traditional methods of psychotherapy, based on psychoanalytic principles, rarely brought success. Disappointed and the results of the use of various drugs. However, in the 1980s, the situation changed due to the emergence of new methods of behavioral therapy and pharmacotherapy, the effectiveness of which was confirmed in large-scale studies. The most effective form of behavioral therapy in obsessive-compulsive disorder is the method of exposure and prevention reactions. The exposition consists in placing the patient in a situation that provokes discomfort associated with obsessions. At the same time, patients are given instructions on how to resist compulsive rituals - preventing a reaction.
The main tools for treating obsessive-compulsive disorder are currently clomipramine or selective serotonin reuptake inhibitors (SSRIs). Clomipramine, having a tricyclic nature, is an inhibitor of serotonin reuptake.
The modern era in the pharmacotherapy of obsessive-compulsive disorder began in the second half of the 60s with the observation that clomipramine, but not other tricyclic antidepressants (such as imipramine), is effective in obsessive-compulsive disorder. Clomipramine, a 3-chlorine analogue of tricyclic imipramine, inhibits the reuptake of serotonin 100 times more than the original substance. These distinctive clinical and pharmacological features of clomipramine allowed us to formulate a hypothesis about the role of serotonin in the pathogenesis of obsessive-compulsive disorder. The advantage of clomipramine over placebo and non-serotonergic antidepressants is confirmed by numerous studies with double-blind control. The effect of clomipramine in obsessive-compulsive disorder has been studied most thoroughly. Clomipramine was the first drug to be approved by the FDA for use in the United States for obsessive-compulsive disorder.
Obsessive-compulsive disorder - Treatment