Journal article

Treating OCD: what to do when first-line therapies fail

David Castle, Peter Bosanac, Susan Rossell



OBJECTIVE: To provide a clinically-focused review of the biological treatment of treatment-resistant obsessive compulsive disorder (OCD). CONCLUSIONS: There is a paucity of research on how to manage OCD patients who fail to respond adequately to first line therapies. High-dose selective serotonin reuptake inhibitors (SSRIs) and clomipramine have good evidence-based data. Combinations of SSRIs have little support in clinical trials, but the combination of SSRIs and clomipramine can be helpful: careful clinical and cardiac monitoring is required. Certain adjunctive antipsychotics have a reasonable evidence base in OCD, but their use also needs to be weighed against the potential side effect bu..

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Funding Acknowledgements

David Castle has received grant monies for research from Eli Lilly, Janssen Cilag, Roche, Allergen, Bristol-Myers Squibb, Pfizer, Lundbeck, Astra Zeneca and Hospira; Travel Support and Honoraria for Talks and Consultancy from Eli Lilly, Bristol-Myers Squibb, Astra Zeneca, Lundbeck, Janssen Cilag, Pfizer, Organon, Sanofi-Aventis, Wyeth, Hospira and Servier; and is a current Advisory Board Member for Lu AA21004 (Lundbeck); Varenicline (Pfizer); Asenapine (Lundbeck); Bitopertin (Roche); Aripiprazole LAI (Lundbeck); and Lisdexamfetamine (Shire). He has no stocks nor shares in any pharmaceutical company.