Are there Anticompulsive or Antiphobic Drugs? Review of the Evidence

Abstract

Summary: Review of 19 uncontrolled studies of antidepressants in phobic and in obsessive-compulsive disorders suggests that such drugs do not act reliably in the absence of symptoms of anxiety-depression (dysphoria). In dysphoric patients the drugs have a broad-spectrum effect not only reducing phobias and rituals but also anxiety-depression, panic, anger, and hostility, all of which are highly intercorrelated, but none yet demonstrated to be the core disturbance. Phobics, but not obsessive-compulsives, have an unusually high dropout rate from treatment when drugs or placebo are given. When antidepressants are stopped, even after 6–8 months, relapse is likely. The drugs do not reduce the liability of many phobics and obsessive-compulsives to have dysphoric episodes over the years. Exposure treatments are more lastingly effective for phobias and for rituals, but do not reduce the liability to later dysphoric episodes.