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Home Formulary 4.0 Central Nervous System 4.3 Antidepressant drugs 4.3.2 Antidepressants for the treatment of anxiety disorders* 4.3.2.4 Obsessive compulsive disorder

4.3.2.4 Obsessive compulsive disorder

ChoiceDrugDosage
1st choiceNon-pharmacological treatment
2nd choicesCitalopram tablets 10mg, 20mg, 40mg [unlicensed indication]Dose:
20mg once daily. If necessary increase the dose gradually up to a maximum of 40mg once a day

(20mg in the elderly and in those with reduced hepatic function)
Or
Fluoxetine capsules 20mgDose:
20mg once daily; if inadequate response after 2 weeks increase gradually to max 60mg once daily
(elderly usual max 40mg once daily but 60mg can be used)
Or
Sertraline tablets 50mg, 100mgDose:
Initially 50mg daily, increased if necessary in steps of 50mg at intervals of at least one week; max 200mg daily

Prescribing Notes

  • Refer to NICE CG 31, Obsessive Compulsive Disorder (OCD)
  • Before starting antidepressants refer to NICE NG215 for information that should be considered and discussed with the patient, including steps to reduce the risk of dependence or withdrawal symptoms
  • The licensed doses of SSRIs in OCD are generally higher than doses used for the treatment of depression
  • Improvement of OCD may not be apparent for 12 weeks. Treatment should be continued for at least 12 months. Long-term maintenance is often necessary
  • Clomipramine and SSRIs have proven efficacy in OCD but clomipramine is associated with more adverse effects

Cautions

See section 4.3.1

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