Objective: To describe a hospitalized patient with refractory obsessive-compulsive disorder (OCD) and to briefly review the supporting literature. Case Summary: A 33-year-old man was admitted with a diagnosis of depression and OCD. Prior drug therapy included numerous medications, but none improved the OCD. Clonazepam therapy was initiated for treatment of anxiety and propranolol was begun to treat his headaches. Sertraline and buspirone were added sequentially to control the symptoms of depression and OCD. Subjective improvement was noted within a few weeks after the combination therapy was begun. Six and four weeks after starting sertraline and buspirone, respectively, the patient's symptoms remain improved. Discussion: Fluoxetine has been shown to be effective in the management of OCD. Sertraline, another selective serotonin-reuptake inhibitor, also looks promising for OCD therapy. Buspirone is a serotonin1A-receptor agonist, and theoretically could augment the effect of selective serotonin-reuptake inhibitors in the treatment of OCD. Conclusions: This patient's OCD symptoms responded to a combination of sertraline and buspirone therapy. It is difficult to confirm whether buspirone augmented the effects of sertraline in this patient. Clinical trials should be developed to determine whether these regimens are, in fact, beneficial in patients with refractory OCD.
Optimization of Clonazepam Therapy Adjusted to Patient’s CYP3A Status andNAT2Genotype
