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
Treatment Resistant OCD
Despite the abundance of reports concerning the efficacy of various agents in OCD, about 20–30% of patients do not respond at all and another 20–30% display only partial response. Possible reasons for treatment refractoriness in OCD are presented below.
Inadequacy of trial
- Duration too short?
- Dose too low?
- Impaired absorption/increased metabolism?
- Noncompliance?
Coexisting condition limits drug efficacy
Incorrect diagnosis?
Exogenous countertherapeutic influences
- Family environment?
- Antiexposure instructions?
Underlying biological heterogeneity
- OCD as a syndrome with multiple etiologies
Search for putative subtypes
In treating these partial or complete non-responders, sound clinical choices are called for. However, as well-controlled, double-blind studies are lacking, many of theseclinical decisions are based on case reports and uncontrolled studies, and therefore, these recommendations should be treated cautiously. Athough the focus here is on the pharmacological approach, we suggest that in cases of partial or non-response, an attempt should be made to combine behavioral therapy (BT) with the pharmacological treatments. BT involves imaginary flooding and in vivo exposure and response prevention. In cases of non-response, family therapy, too, should be suggested, in order to assess the family dynamics and to determine whether there is a family member who cooperates with the patient’s disorder—for example, impedes exposure trials—hence preventing any improvement.