Obsessive Compulsive Disorder
- Epidemiology
- Comorbidity
- OCD and Tic Disorder
- OCD and Depression
- OCD and Other Anxiety Disorders
- OCD and Phobia
- OCD and OCPD
- OCD and Schizophrenia
- Course and Prognosis
- Etiology
- Specific Clinical Response
- Serotonin Antagonists
- Pharmacological Challenges
- Dopamine
- Immune Factors
- Brain Imaging Studies
- Genetics
- Other Biological Data
- Behavioral Factors
- Psychosocial Factors
- Treatment of OCD
- Efficacy of Serotonergic vs Adrenergic Antidepressants
- Long Term Treatment of OCD
- Drug Dosage
- Psychological Approaches
- Treatment Resistant OCD
- Switching Medications
- Augmentation
- Risperidone
- Pindolol
- Other Options
- Intravenous Clomipramine
- Monoamine Oxidase Inhibitors
- Last-line Therapies
Monoamine Oxidase Inhibitors (MAOIs)
A placebo-controlled trial of fluoxetine and phenelzine for OCD provides no evidence to support the use of phenelzine in OCD except possibly for patients with symmetry-related or other atypical obsessions. An earlier controlled, comparative study of CMI and clorgyline, a reversible MAO-A inhibitor, also failed to show any beneficial effect of MAOIs. Only one small, controlled study, which compared phenelzine and CMI (without placebo) suggests that they are similar. Doses of phenelzine up to 90 mg/day should be used for at least 10 weeks. As some OCD patients may be hypersensitive to the activation of their serotonergic systems, specific attention should be paid, on the one hand, to the dangerous combination of SSRIs and MAOIs, and, on the other hand, to the longer wash-out periods for serotonergic medication needed by OCD patients before initiating MAO treatment. Hence the wash-out period needed for discontinuation of CMI and other SSRIs having a relatively short half-life (such as fluvoxamine and sertraline) for OCD patients should be at least four weeks, whereas with fluoxetine it should be even longer (at least six weeks).