Don't Forget the Tricyclics

Peter M. Yellowlees, MBBS, MD


October 10, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. Now a team of investigators[1] from University College, London, have undertaken a study of all randomized controlled trials (RCT) of OCD published prior to December 2014 to determine the clinical effectiveness, acceptability, and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents, and adults. The researchers undertook a systematic review of 86 RCTs and a network meta-analysis of 71 RCTs, including over 7000 patients in total. They found that in adults, psychological interventions, clomipramine, selective serotonin reuptake inhibitors (SSRIs), or a combinations of these are all effective; whereas in children and adolescents, where there were few trials, psychological interventions—either as monotherapy or combined with SSRIs—were more likely to be effective.

How is this review helpful from a clinical perspective? Primarily it confirms what most experienced clinicians already know: that OCD is a very treatable disorder, especially when clomipramine or SSRIs are combined with cognitive-behavioral therapy. These days, when many young psychiatrists are not being taught about tricyclics and rarely prescribe them, it is important to remember that they are effective for many disorders, including OCD, and should not be forgotten, especially as we become increasingly aware of some of the longer-term side effects of SSRIs and related medications.

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