Sequential Trials of Fluoxetine, Phenelzine, and Tranylcypromine in the Treatment of Obsessive-Compulsive Disorder

The effects of fluoxetine, phenelzine, and tranylcypromine in obses- sive-compulsive disorder (OCD) were compared in an open-label pilot study in- volving sequential treatment with these agents in six patients. Despite full (or maximally tolerated) trials on these medications, there was no improvement in OC symptoms referable to the pharmacotherapy. Three patients, however, subse- quently showed major improvement in symptoms following application of behav- ioral therapy techniques. Despite the small sample size, this study suggests that there may be many patients with OCD for whom these medications might be poorly tolerated or inef- fective, and emphasizes that behavioral-therapeutic techniques can be effective in patients for whom medications prove ineffective or intolerable. Of note, one pa- tient displayed simultaneous manic and OC symptoms, thus undermining pre- vious suggestions that the coexistence of these symptoms may not be possible. Several studies have found the serotonin reuptake inhibitor fluoxetine to be effective in the treatment of patients with obsessive-compulsive disorder (OCD) (Fontaine & Chouinard, 1986; Sommi, Crimson, & Bowden, 1987; Turner, Jacob, Beidel, & Himmelhoch, 1983, and several case reports suggest that the monoamine oxidase inhibitors (MAOIs) phenelzine and tranylcypromine may also be helpful in some patients