Summary

The treatment of OCD was characterized by pessimism until 20 years ago when effective treatments using behavioural therapy and the serotonin reuptake inhibitors were developed. Although introduced for OCD in 1967, it was only in the 1980s that double-blind studies confirmed the efficacy of clomipramine, an SRI. This was followed by the introduction of the selective serotonin reuptake inhibitors, which also proved effective for OCD. The anti-obsessive activity of these drugs was found to be independent from the drugs' antidepressant effect, as established by their efficacy both in depressed and non-depressed patients. Overall, serotonergic therapies have provided a better outlook for these patients and have increased our understanding of the pathophysiology of OCD. (6,7) Previously thought to be a rare and untreatable disorder, OCD is now recognized as common, and there is good reason to expect that patients with OCD will benefit substantially from behaviour therapy and potent SRIs.

Many patients with OCD do not seek treatment and the disease tends to be chronic. There is a 10-year lag between the onset of symptoms and the seeking of professional help due to feelings of embarrassment. Further delay ensues until the diagnosis and correct treatment are given. (61) Census data suggest that over $8 billion are spent in the United States each year on the management of OCD, one-fifth of that spent on cardiac disease. (62) Because patients with OCD often attempt to conceal their symptoms, it is incumbent on clinicians to screen for OCD in every mental status examination, since appropriate treatment can result in improved quality of life, reduced OCD chronicity, and reduced costs to the individual and society.

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