Pharmacotherapy

There has been little research examining the efficacy of pharmacotherapy interventions among people with co-occurring OCD and AOD use. A Cochrane review of pharmacotherapy for anxiety and co-occurring alcohol use disorders found no rigorously conducted trials of medication treatment for co-occurring OCD and alcohol use [1172]. In view of the lack of evidence for pharmacological interventions for co-occurring OCD and AOD use, clinicians may be guided by the body of research that has been conducted for single disorder OCD.

Evidence from systematic reviews and meta-analyses examining RCTs of pharmacotherapies for single disorder OCD have found that the SSRIs citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline; the SNRI venlafaxine; and the TCA clomipramine, to be associated with reductions in symptom severity and improvements in health-related quality of life [1227, 1232, 1239–1247]. There is some evidence that the use of the second-generation antipsychotics are associated with reductions in OCD symptoms [1248]; however, adverse side effects may limit their utility.

Evidence-based guidelines for the treatment of single disorder OCD recommend that SSRIs be used as the first line of pharmacotherapy, and further suggest that the combination of psychological and pharmacological treatments is likely to be superior to either approach in isolation, particularly among those with severe OCD [1227, 1232]. Research has found a positive dose-response relationship for SSRIs, with greater symptom improvements found among those who are taking higher doses of SSRIs [1238]. Table 51 provides a list of SSRIs for the pharmacological treatment of single disorder OCD. It should be noted that there is commonly a delay in the onset of effect of up to 12 weeks, although depressive symptoms improve more quickly [1235].

Adapted from Australian Government Department of Health [1119] and the Therapeutic Goods Administration [987]. For a full list of generic brands available, see the Therapeutic Goods Administration website (http://www.tga.gov.au).