Obsessive-compulsive disorder (OCD) is a chronic condition that requires long-term management. Symptoms are likely to recur within a few weeks of treatment discontinuation. Long term treatment is then needed in order to maintain the response achieved during acute phase pharmacotherapy, hence avoiding relapses. Several placebo-controlled studies are available in the literature, demonstrating the efficacy of maintenance treatment in preventing relapses. On second instance, acute phase treatment often leads to a partial improvement in obsessions and compulsions, to the extent of 30-60% in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score: long term treatment is often needed to keep the improvement up. This is also true in terms of quality of life, whose improvement is often delayed and obtained during the long term. Several authors suggest that, in maintenance treatment, drug dosages can be reduced between 40% and 60% of those used in acute episodes. In clinical practice, OCD patients continue to take medication for at least 1 year, although the vast majority of patients requires maintenance treatment whose duration is much longer. When considering long-term pharmacological treatments, tolerability has to be considered. While side effects can possibly be tolerated during the acute phase of the disorder, in fact, when obsessive-compulsive symptoms are disrupting and painful, the same side effects could be considered unbearable when patients experience a relief from symptoms and further treatment is needed in order to avoid relapses.
