Strong evidence supports the efficacy of pharmacotherapy with serotonin reuptake inhibitors (SRIs) (this includes the tricyclic antidepressant clomipramine as well as the selective serotonin reuptake inhibitors such as paroxetine, fluvoxamine, fluoxetine, citalopram, escitalopram, and sertraline) for children and adults with OCD.
Approximately 40-60% of OCD patients respond to an SRI, and the mean improvement of symptoms is about 20-40%. The probability of full remission of OCD is only about 12%. Relapse rates after medication discontinuation are approximately 90%. Although clomipramine has yielded a larger effect size than the selective SRIs, many patients have trouble tolerating the side effects of clomipramine.
In light of the fact that SRI treatment more often results in partial remission of OCD symptoms compared to complete remission, and changes in psychosocial functioning often lag behind symptom reductions, examining quality of life and long-term functioning of individuals with OCD is critical.
Poor insight is generally considered to be a patient’s relative lack of understanding of the degree to which his or her obsessions and compulsions are unreasonable or excessive. Poor insight has been associated with more severe OCD, co-occurring depression, and somatic obsessions. Poor insight OCD patients appear to respond equally well to SRI treatment as those with good insight, provided they are compliant. The addition of an antipsychotic medication does not appear necessary for the treatment of poor insight OCD. OCD patients with poor insight, however, appear to respond less robustly to exposure response prevention therapy.