The clue to baffling OCD: serotonin deficiency - obsessive-compulsive disorder

Nutrition Health Review, Wntr, 1991

The discovery that serotonin-uptake inhibitors help patients with obsessive-compulsive disorder has encouraged researchers to deal with results before concentrating on the problem's cause -- reversing the usual direction of scientific investigation.

Because more than 2% of Americans suffer from a disorder that is just beginning to be understood, concerned OCD specialists are urging psychiatrists to learn how to deal with an affliction that can severely intrude upon a patient's life, yet is not a psychiatric disorder in the strict sense of the term. It is now viewed as a genetically determined biological problem.

Three drugs that enhance serotonin levels in the nervous system have been shown to benefit OCD patients, said Dr. Thomas Insel at a meeting on the neuropharmacology of serotonin. Dr. Insel is a senior staff scientist at the National Institute of Mental Health in Bethesda, Md. "The agents, serotonin inhibitors, slow clearance of the substance from the synapses of neurons that use serotonin as a neurotransmitter," Dr. Insel noted. (Brain messages pass between neurons with the aid of chemicals. Serotonin is a principal transmitter. When the transmitting agents malfunction, thought processes are affected.)

"The agent with the best record for treating OCD successfully is clomipramine," said Dr. John Griest, a professor of psychiatry at the University of Wisconsin at Madison.

The other two drugs are Prozac and Fluvoxamine. The three drugs have side-effects, Dr. Insel said, but of those who tolerate the treatments, about 50% show improvement.

The experts agreed that behavioral therapy can be a useful complement and that primary-care physicians can learn the techniques easily.

Dr. Insel also noted that the OCD benefits of serotonin-uptake inhibitors were discovered by accident, and "the theory hasn't yet caught up with the practice."