E X P E R T O P I N I O N An emerging role for escitalopram in the treatment of obsessive-compulsive disorder Dawson W Hedges Fu Lye M Woon Department of Psychology and the Neuroscience Center Brigham Young University, Provo, UT, USA Correspondence: Dawson W Hedges Department of Psychology and the Neuroscience Center, Brigham Young University, 1001 SWKT, Brigham Young University, Provo, Utah, 84602, USA Email dawson_hedges@byu.edu Abstract: Obsessive-compulsive disorder (OCD) is a common and severe neuropsychiatric disorder treated by both behavioral and pharmacologic techniques. Despite the availability of treatments for OCD, including the selective serotonin reuptake inhibitors (SSRIs), many OCD patients have an inadequate response to current treatments. As such, additional approaches to the management of OCD are required. A potential but little studied treatment for OCD is the SSRI escitalopram. Escitalopram is the S-enantiomer of citalopram, the preparation containing both S and R enantiomers of citalopram. Not only is escitalopram the most selective of the SSRIs, it is also devoid of R-citalopram, which may interfere with the effects of the S enantiomer. Escitalopram appears to be effective in depression and several anxiety disorders, including social anxiety disorder and generalized anxiety disorder, conditions in which it also appears reasonably well tolerated. Enantiomeric speciﬁcity, high serotonin reuptake selectivity, comparatively good tolerability and favorable pharmacokinetics, and preliminary evidence of efﬁcacy in OCD suggest a potential role for the use of escitalopram in the treatment of OCD. Nevertheless, additional work including evaluating the use of escitalopram with behavioral interventions and in long- term treatment of OCD is needed to clarify its overall role in managing OCD. Keywords: escitalopram, obsessive-compulsive disorder, pharmacotherapy Introduction to management of obsessive-compulsive disorder Characterized by obsessions, compulsions, considerable functional impairment, and once thought to be quite rare (Abramowitz 1997), obsessive-compulsive disorder (OCD) may occur in up to approximately 2.4% of the population in North America (Karno et al 1988) and typically presents in a person’s early 20s (Abramowitz 1997). For many patients, OCD tends to be chronic, with many people experiencing features of OCD over decades (Skoog and Skoog 1999). People with OCD also suffer from a lower quality of life compared with healthy controls (Moritz et al 2005). Both psycho- therapeutic and psychopharmacological approaches either singly or together are used in the treatment of OCD. The relationship between treatment response and quality of life in people with OCD is not entirely clear, but some data suggest that quality of life improves with treatment response (Moritz et al 2005). Initially consisting of psychoanalysis, psychotherapy for OCD now uses the more effective exposure and response prevention techniques, cognitive therapy, or thought- stopping approaches (Abramowitz 1997). It is unknown, however, whether exposure and response prevention approaches and cognitive therapy work through separate mechanisms or via common factors, although Abramowitz (1997) concluded that these two therapies work through a similar mechanism due to lack of a differential response between cognitive and physiological features of OCD. Nevertheless, exposure and response prevention treatment not only appears helpful in the short-term treatment of OCD, but also seems to be associated with lower relapse rates compared with Neuropsychiatric Disease and Treatment 2007:3(4) 455–461 © 2007 Dove Medical Press Limited. All rights reserved 455