Il trattamento farmacologico del disturbo ossessivo-compulsivo: quali opzioni oltre gli inibitori del re-uptake della serotonina?
Year: 2007
Type: article
Abstract: Summary Objectives During the past 25 years, a large number of controlled studies have established the efficacy of pharmacological treatment for obsessive-compulsive disorder (OCD). First-line pharmacological treatment of OCD consists of drugs with potent serotonin-re-uptake inhibition properties (SRIs) such as clomipramine, fluvoxamine, paroxetine, sertraline, fluoxetine and citalopram. Clomipramine might be slightly more effective than SSRIs. These medications have reduced obsessive-compulsive symptoms in randomized placebo-controlled trials; however, up to 12 weeks of treatment is required to determine treatment response, and 40% to 50% of patients do not experience clinically significant improvement on treatment with these medications. Moreover, a long-term treatment is often needed in order to maintain the response achieved during acute phase pharmacotherapy, therefore tolerability has to be considered: some adverse events, such as weight gain and sexual dysfunctions could be considered unbearable by patients during long-term treatment. As a consequence, other medications have been tested as monotherapies of OCD. The present review gathers data available on alternative medications (to SRIs) as monotherapy of OCD. Methods A medline search was conducted to identify relevant articles on alternative monotherapies of OCD. Double-blind, placebo controlled studies as well as open label studies and case reports were included. Results It might be expected that other agents that influence the serotoninergic and dopaminergic systems may be useful anti-obsessional therapy, but data from clinical trials of alternative monotherapies for the treatment of OCD have not unequivocally shown that any of these agents is efficacious. Trials have focused primarily on other antidepressants, anxiolytics, and other experimental agents. Most of the tested agents (monoamine oxidase inhibitors, benzodiazepines, opioids, hormonal agents, Hypericum perforatum, amphetamine, nicotine, ondansetron) show some efficacy in case reports or in open-label trials, but failed to demonstrate efficacy when tested under double-blind conditions. Few active principles seem to be useful as potential anti-obsessional agents. Several case reports and open-label trials have suggested that venlafaxine could be a beneficial anti-obsessional monotherapy. Moreover, recent double-blind randomized studies show that venlafaxine is equally as effective as paroxetine in treating OCD patients. Among anxiolytics, one controlled trial found buspirone, a 5-HT 1A (serotonin 1A receptor) partial agonist, as efficacious as clomipramine in the treatment of OCD (the response rate for both agents was greater than 55%), but this finding has not been confirmed. One controlled study of inositol, a precursor for the second messenger phosphatidyl-inositol system, demonstrated efficacy in the treatment of OCD (Table I).
Language: Italian
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W2240383168