220.127.116.11 Obsessive compulsive disorder
|1st choice||Non-pharmacological treatment|
|2nd choices||Citalopram tablets 10mg, 20mg, 40mg [unlicensed indication]|
Dose: 20mg one daily. If necessary increase the dose gradually up to a maximum of 40mg once a day day (20mg in the elderly and in those with reduced hepatic function)
|Fluoxetine capsules 20mg; liquid 20mg/5ml|
(elderly usual max 40mg once daily but 60mg can be used)
|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
- Refer to OCD, NICE CG 31.
- 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.
See cautions here.