Beyond first line therapy

It is not an understatement to say that there is a tremendous amount of room for improvement for an effective and sustained treatment for OCD, especially for those with severe or debilitating conditions that are resistant to first line drugs and/or CBT. The erratic and often unsatisfactory results from first line therapy are the principal reasons that researchers continue efforts to identify promising new drugs and maximise the effectiveness of those currently available.

At least 25 drugs have been tested or used for OCD treatment. Most of these are reserved for those patients with poor responses to first line therapies although the evidence supporting their effectiveness is often conflicting or insufficient. In the opinion of many experts, the combination of psychotherapeutic interventions with multi-drug therapy is more likely to be effective in patients with severe OCD. There also are non-drug treatments that have attracted attention. These include nutrient supplements, plant and herbal preparations, acupuncture, and alternative psychosocial interventions. For patients who do not have satisfactory results from numerous drugs and CBT, brain stimulation treatment methods are also presented.

FACTORS THAT MAY PLAY A ROLE IN FAILED TREATMENT

If optimal first line drug and/or behavioural therapies are not adequately effective, most specialists will prescribe second line treatment.

DRUG CLASS: ATYPICAL ANTIPSYCHOTIC DRUGS (AAP)

Drugs in this group are used to treat several serious psychiatric disorders. These medications, also referred to as neuroleptics, are in a class of…

AMISULPRIDE & D-CYCLOSERINE (SEROMYCIN)

Amisulpride is discussed separately since it shows promise as an AAP in OCD, but is as yet understudied and not a mainstream OCD drug.

MEMANTINE (NAMENDA), RILUZOLE (RILUTEK) & OTHER DRUGS

Memantine’s principal action results in suppression of glutamate activity. Several studies of the addition of memantine to SSRI have shown generally…

BRIEF MENTIONS

This drug stimulates GABA production, thereby inhibiting glutamate release. Several case reports and case series have demonstrated improvement of OCD symptoms …