Greist J H, Jefferson J W
University of Wisconsin Medical School, Madison 53717-1914, USA.
Br J Psychiatry Suppl. 1998(35):64-70.
Pharmacotherapy for obsessive-compulsive disorder (OCD) was seldom beneficial before clomipramine, a potent selective serotonin reuptake inhibitor (SSRI), became available. Subsequent progress in pharmacotherapy for OCD has increased the possibility of effective treatment for most sufferers.
Randomised controlled trials of pharmacotherapy for OCD were reviewed, as well as reports of beneficial pharmacotherapy found in open trials and case reports.
SSRIs are well-tolerated by patients with OCD, even in large doses. Proserotonergic augmentation is seldom helpful but antipsychotic augmentations seem beneficial for many OCD patients with comorbid tics.
Potent SSRIs are the pharmacotherapy of choice for OCD, with a more limited role reserved for monoamine oxidase inhibitors. If one SSRI is ineffective, others may be beneficial. Non-drug therapies are also important in OCD: behaviour therapy is frequently helpful but infrequently available and neurosurgery is sometimes helpful when all other treatments have failed.
在强效选择性5-羟色胺再摄取抑制剂（SSRI）氯米帕明问世之前，强迫症（OCD）的药物治疗很少有效果。随后强迫症药物治疗方面的进展增加了大多数患者有效治疗的可能性。
回顾了强迫症药物治疗的随机对照试验，以及开放试验和病例报告中发现的有益药物治疗报告。
强迫症患者对SSRI耐受性良好，即使大剂量使用也是如此。5-羟色胺能增强疗法很少有帮助，但抗精神病药物增强疗法对许多伴有共病性抽动的强迫症患者似乎有益。
强效SSRI是强迫症药物治疗的首选，单胺氧化酶抑制剂的作用较为有限。如果一种SSRI无效，其他药物可能有效。非药物疗法在强迫症治疗中也很重要：行为疗法通常有帮助，但很少能获得，当所有其他治疗均失败时，神经外科手术有时会有帮助。
