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The Pharmacological Treatment of Refractory OCD 

The Pharmacological Treatment of Refractory OCD
Chapter:
The Pharmacological Treatment of Refractory OCD
Author(s):

Christopher Pittenger

DOI:
10.1093/med/9780190228163.003.0041
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date: 26 June 2022

Evidence-based interventions for OCD, both psychotherapeutic and pharmacological, are of benefit to many. However, even when optimally deployed, first- and second-line treatments leave a substantial fraction of patients—perhaps as many as 20% to 25%—without meaningful improvement. Furthermore, many who are classified as “responders” to first- and second-line treatments continue to have substantial residual symptoms and attendant morbidity. This chapter reviews various pharmacological strategies that have been used for the treatment of refractory OCD, including agents targeting serotonin, dopamine, and glutamate neurotransmission. Although the evidence base supporting the use of these agents is not as robust as it is for first-line interventions, many have shown promise in some studies. The prevalence of refractory OCD symptoms means that such pharmacological strategies must frequently be considered in clinical practice, despite the lack of definitive guidance from controlled studies.

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