Studies have shown that Hoarding Disorder does not usually respond well to medications. The more severe a person’s hoarding is, the less likely they will respond to treatment with a serotonin reuptake inhibitor (SRI) (this includes the tricyclic antidepressant, clomipramine, as well as the selective serotonin reuptake inhibitors such as paroxetine, fluvoxamine, fluoxetine, citalopram, esci- talopram, and sertraline). Previous studies have however generally involved OCD patients who had hoarding symptoms and not individuals with Hoarding Disorder as it is currently defined in DSM-5.
Given the limited efficacy data for medications, the first-line treatment for Hoarding Disorder should be cognitive behavioral therapy (CBT).
If medication is used, the usual approach is to start with SSRIs. Even though hoarding is a statistical predictor of poor response, there are still some individuals with hoarding who do respond to SSRIs.
Medications such as SSRIs may also be beneficial especially for co-occurring depression or anxiety. A stimulant may be useful for co-occurring ADHD.