Compulsive hoarding is a common and potentially disabling disorder. This article reviews studies of the effects of hoarding on response to serotonin reuptake inhibitor (SRI) medications in patients with obsessive-compulsive disorder (OCD), as well as recent studies of pharmacotherapy specifically for patients with the compulsive hoarding syndrome. Taken together, the results of these studies indicate that the "conventional wisdom" that compulsive hoarding does not respond well to SRI treatment is wrong. SRIs appear to be as effective for compulsive hoarders as for nonhoarding OCD patients. A case is presented of a compulsive hoarding patient who responded well to pharmacotherapy with a novel agent. Symptom improvement from pharmacotherapy of compulsive hoarding appears to be at least as great as that resulting from cognitive-behavioral therapy (CBT). However, the combination of pharmacotherapy and CBT for compulsive hoarding is likely more effective than either treatment alone.