Drug treatment of obsessive-compulsive disorder: a review of findings in the light of diagnostic and metric limitations.

Nearly every category of psychotropic drug has been investigated in an attempt to find a pharmacologic treatment for obsessive compulsive disorder (OCD). This study reviews published trials from the English literature in which tricyclic antidepressants, monoamine oxidase inhibitors, neuroleptics, benzodiazepines, and other agents were employed for treatment of OCD. Weaknesses in the current methodology including diagnosis, measurement of severity and criteria for improvement have contributed to invalid conclusions about drug treatment and efficacy. It appears that OCD is an etiologically heterogeneous disorder with a complex differential diagnosis. For the clinician, a major conclusion drawn from this review is that no agent emerges as a drug of choice. Although clorimipramine, the most actively investigated agent, shows some promise, it has not been conclusively demonstrated that other, more readily available heterocyclic agents are less effective. Furthermore, when other disorders co-exist, such as panic disorder, alternative agents may prove as effective.