In this excerpt, psychiatrist Ian Osborn traces the history of medications for OCD since the 1960s.
The textbook I used in medical school [around 1970], Freedman and Kaplan's Comprehensive Textbook of Psychiatry, taught Freud's theories and suggested treating OCD with psychoanalysis. Regarding the use of medications, the authoritative text stated: "There are no drugs that have a specific action on the obsessive-compulsive symptoms...." I remember dutifully attempting to interpret my OCD patients' dreams in order to get to the roots of their unconscious conflicts, while avoiding prescribing anything.
...[But] [i]n 1967, a Spanish psychiatrist, Lopez-Ibor, reported a drug that was specifically effective for OCD, clomipramine (Anafranil). Many case reports of its successful use followed, and in the 1980s more than fifteen double-blind and placebo controlled studies demonstrated beyond a doubt that it was a uniquely effective treatment for OCD.
Clomipramine was developed by chemists who added a chlorine atom to the molecular structure of the standard antidepressant imipramine in the hopes of finding a better antidepressant. Instead, fortuitously, the new agent was observed by psychiatrists to be helpful for OCD. Imipramine itself had been developed through experimental changes to the molecule of a certain antihistamine, done in the hope of building a better antihistamine. The compound was accidentally observed to work in the treatment of depression. All of the early breakthroughs in medication treatments for mental disorders were due to such serendipity.
In the 1970s, however, a remarkable advance in pharmacological research technique ushered in a whole new era in the development of drugs for psychiatric disorders. Solomon Snyder and colleagues at Johns Hopkins University developed a practical method of screening drugs for their effects on specific chemicals in the brain. The key discovery was finding a way to keep brain tissue chemically alive after an animal had been sacrificed. Using this technique, a rat could then be given a drug, sacrificed, and its brain tissue examined to see what effects that drug was having on various brain chemicals. Serendipity was no longer necessary. "Designer drugs" with specific effects on certain neurochemicals could now be developed.
Prozac, Luvox, Zoloft, and Paxil were all designer drugs, identified by their specific effects on serotonin. All have been proven very effective anti-OCD agents. Prozac was the first to be introduced in the United States....1
1Ian Osborn, Tormenting Thoughts and Secret Rituals: the hidden epidemic of obsessive-compulsive disorder (New York: Dell Publishing, 1998), 228-9.
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