Resistant obsessive compulsive disorder and treatment alternatives

Obsessive compulsive disorder is an anxiety disorder that is characterized with obssessions and/or compulsions, causes disability, and impairs the quality of life. It has chronic course and a recurrent characteristic. The ratio of patients with resistant obsessive compulsive disorder is relatively high. Resistance is defined as that is no response in spite of using in maximum dosage and enough duration at least two serotonin reuptake inhibitors or two antidepressants from different groups or clomipramine and a serotonin reuptake inhibitor. The ratio of response to first line drugs is between 40% and 60%. In resistant patients, the diagnosis, the former treatments, compliance to treatments, comorbidity must be carefully evaluated. The treatment alternatives include changing drug, augmentation with cognitive behavior therapy, the combination of two serotonin reuptake inhibitors, the using intravenous serotonin reuptake inhibitors (clomipramine, citalopram), the augmentation treatments (the other antidepressants, antipsychotics, mood stabilizers, glutamatergic agents, benzodiazepines), alternative monotherapies (MAOls, venlafaxine, sumatriptan, glutamatergic agents, psychostimulants, buspirone, tramodol). The other treatment alternatives except for drug treatments are cognitive behavior therapy, electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation. Psychosurgery is the last alternative in resistant patients with nonresponsive to any treatment. The benefits of alternative treatments except for drug treatments and cognitive behavior therapy is not definite. (Anatolian Journal of Psychiatry 2010; 11:269-278)