Sequential trials of fluoxetine, phenelzine, and tranylcypromine in the treatment of obsessive-compulsive disorder

The effects of fluoxetine, phenelzine, and tranylcypromine in obsessive-compulsive disorder (OCD) were compared in an open-label pilot study involving 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, subsequently showed major improvement in symptoms following application of behavioral 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 ineffective, and emphasizes that behavioral-therapeutic techniques can be effective in patients for whom medications prove ineffective or intolerable. Of note, one patient displayed simultaneous manic and OC symptoms, thus undermining previous suggestions that the coexistence of these symptoms may not be possible.