Therapy gains with sertraline were maintained with continued medication as long as they remained on active medication, without

tolerance developing. The 59 patients who completed this study were followed up for a second year on open-label sertraline, whereupon they showed additional clinical Inhibitors,research,lifescience,medical improvements.169 Another trial with paroxetine demonstrated continued efficacy for 12 months in the majority of patients.170 The effectiveness of potent SRIs is now well established in the treatment of OCD, but despite these advances, nearly 40% to 60% of patients experience minimal to no improvement, in symptoms with these treatments. Furthermore, in patients who do respond to SRIs, the degree of improvement, is often incomplete, Inhibitors,research,lifescience,medical with few patients experiencing full symptom remission.171 For these reasons, attempts to augment or improve the average response with pharmacological strategies targeting serotonergic or other neurotransmitter systems are routine. There is no agent that is routinely effective as an augmenting agent, although there is some support for clonazepam, clonidine, trazodone, nefazodone, tryptophan, and pindolol.172 There is clear evidence of benefit for traditional neuroleptics173 Inhibitors,research,lifescience,medical and more recently the atypical

neuroleptics (eg, risperidone, olanzapine, and quetiapine), principally in the patients with OCD who have comorbid tic disorders.174-177 Intravenous clomipramine has also been shown to be more effective than oral administration.178,179 Two controlled studies were performed to test the MAOI PI3K activity phenelzine Inhibitors,research,lifescience,medical efficacy in OCD. Inhibitors,research,lifescience,medical The first one180 found phenelzine (up to 75 mg/day) and clomipramine (up to 225 mg/day) both effective with no significant difference between the two drugs, while another one comparing phenelzine (60 mg/day)

with fluoxetine (80 mg/day) and placebo found that phenelzine was no better than placebo.181 Other drugs Buspirone produced an effect, similar to clomipramine Urease in a small double-blind study with 18 patients,182 but the results from controlled trials of buspirone augmentation to SRIs were less encouraging.183,181 Inositol (18 mg/day) was superior to placebo and well tolerated in a short-term, double-blind, controlled trial with crossover design performed in OCD.185 Lithium has been suggested to further reduce obsessivecompulsive symptoms when added to therapy with antidepressants,186-188 although controlled studies have not substantiated these observations,189 and gabapentin was reported to further reduce OC symptoms when added in an open-label manner to ongoing fluoxetine (30-100 mg/day) treatment, in five OCD patients.