Although pharmacological treatments for OCD are effective, they are not superior to the standard psychological intervention, exposure and ritual prevention (ERP). ERP is at least as effective in the short term, free from side effects and associated with greater long-term gains than current drug regimens (Greist 1998b; Marks 1997; see further, Chapter 15). As will be discussed, drug treatment, when effective, is generally continued indefinitely, as relapse is the norm on discontinuation. It is, however, more rapidly accessed, cheaper (at least initially) and generally more convenient for the patient than pursuing ERP, which involves challenging exposure tasks. One should therefore resist the temptation to prematurely medicate patients presenting for the first time unless they have a particular preference for drug treatment, object to ERP or where ERP is unavailable. Cases of significant co-morbid depression are an exception and are probably best treated with medication initially (Marks, 1997). Although there is some evidence of additional benefit from combining pharmacological treatment and ERP in uncomplicated cases (Greist, 1998b, O'Connor et al., 1999), medication should ideally be reserved for patients inadequately responsive to psychological treatment alone.
As early as 1959, evidence was emerging of the anti-obsessional potential of drugs that enhance the availability of the neurotransmitter serotonin
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.