A study published in the journal Human Psychopharmacology: Clinical and Experimental examines international trends in the treatment of obsessive-compulsive disorder (OCD).

Data from 19 expert centers from 15 countries were collected via a standardized data collection sheet, which assessed the use of medications, psychological therapies, and other biological treatments (transcranial magnetic stimulation [TMS], deep brain stimulation). Specifically, the psychotropic drugs included for evaluation were selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenalin reuptake inhibitors (SNRIs), clomipramine, other tricyclic antidepressants, mirtazapine, reboxetine, benzodiazepines, atypical antipsychotics, typical antipsychotics, sodium valproate, lithium, and any other psychotropic drugs.

The total sample included 7340 patients with OCD, with data collected between 1990 and 2018. Results showed that approximately 53% of patients (N=3910) were being treated with an SSRI; fluoxetine (13.2%; N=972) and fluvoxamine (12.4%; N=913) were the most commonly prescribed. With regard to SNRIs, as venlafaxine was the only one available in most countries, use was reported to be between 2% to 10%.

Use of atypical antipsychotic agents was observed in 23.3% (N=1638) of the sample. The most commonly used antipsychotic agents were risperidone (7.3%; N=428) and aripiprazole (7.1%; N=415); fewer than 5% (N=275) of patients were taking typical antipsychotic agents. Lithium was the most commonly used mood stabilizer (3.9%; N=238); other mood stabilizers and anticonvulsants were used less frequently. Benzodiazepine use was reported in 15% of the sample, which the authors noted, may be due to co-occurring anxiety disorders.

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Generally, nonpharmacologic therapies were not commonly used. Neurostimulation techniques such as TMS, deep brain stimulation, gamma knife surgery, and psychosurgery were utilized in <1% of the patient sample. Only a little over 30% of patients were reported to have received exposure and response prevention (ERP) therapy, which in several clinical guidelines is considered a first-line treatment.

“The variation between countries in treatments used for OCD needs further evaluation,” the authors concluded, adding that “The findings emphasize the need for updated and well‐circulated treatment guidelines for OCD.” 

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