McDougle C J, Goodman W K, Price L H
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Pharmacopsychiatry. 1993 May;26 Suppl 1:24-9. doi: 10.1055/s-2007-1014373.
Potent inhibitors of 5-hydroxytryptamine (5-HT) reuptake have clearly been established as the first-line pharmacotherapy for treatment of obsessive-compulsive disorder (OCD). Although a variety of tricyclic antidepressants and monoamine oxidase inhibitors have similar efficacy in the treatment of depression and panic disorder, potent blockade of 5-HT transport appears to be a prerequisite for effective treatment of OCD. Adding agents that enhance 5-HT neurotransmission to ongoing treatment in patients whose OCD is refractory to 5-HT reuptake inhibitors has not yielded impressive results. However, the addition of low-dose dopamine (DA) antagonists to the regimens of treatment-resistant patients appears to be a potentially useful strategy for the specific subgroup of OCD patients with a comorbid chronic tic disorder such as Tourette's syndrome. Because of the toxicity associated with neuroleptics, a time-limited trial of those agents, with reassessment at regular intervals, is indicated. Pharmacologic studies suggest that both the 5-HT and DA systems may be critical to the treatment and possibly the pathophysiology of OCD.
5-羟色胺（5-HT）再摄取强效抑制剂已明确被确立为治疗强迫症（OCD）的一线药物疗法。尽管多种三环类抗抑郁药和单胺氧化酶抑制剂在治疗抑郁症和恐慌症方面有相似疗效，但强效阻断5-HT转运似乎是有效治疗OCD的一个先决条件。在对5-HT再摄取抑制剂难治的OCD患者的持续治疗中添加增强5-HT神经传递的药物，并未产生令人瞩目的效果。然而，对于患有共病慢性抽动障碍（如妥瑞氏综合征）的特定OCD患者亚组，在难治性患者的治疗方案中添加低剂量多巴胺（DA）拮抗剂似乎是一种潜在有用的策略。由于与抗精神病药物相关的毒性，建议对这些药物进行限时试验，并定期重新评估。药理学研究表明，5-HT和DA系统可能对OCD的治疗以及可能的病理生理学都至关重要。
