| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | Non-pharmacological treatment | |
| 2nd choices | Citalopram 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 20mg | Dose: 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, 100mg | Dose: 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