## First-Line Pharmacotherapy for OCD **Key Point:** **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line pharmacological agents for OCD, supported by robust evidence and international guidelines (APA, NICE, Indian Psychiatric Society). ### Why SSRIs Are First-Line | Feature | SSRIs | TCAs | Benzodiazepines | Antipsychotics | |---------|-------|------|-----------------|----------------| | Efficacy in OCD | High (serotonergic mechanism) | Moderate | Minimal | Adjunctive only | | Safety profile | Good | Anticholinergic side effects | Dependence risk | Metabolic effects | | Evidence base | Extensive RCTs | Limited | Not recommended | Augmentation role | | First-line status | **Yes** | No | No | No | ### Effective SSRIs for OCD - Fluoxetine (40–80 mg/day) - Sertraline (50–200 mg/day) - Paroxetine (40–60 mg/day) - Fluvoxamine (100–300 mg/day) **High-Yield:** SSRIs require **higher doses and longer duration** (8–12 weeks) compared to depression treatment. This is a frequently tested distinction. **Mnemonic:** **SSRI-OCD** — SSRIs are the gold standard; doses are higher; response takes longer. **Clinical Pearl:** If one SSRI fails, switching to another SSRI or adding cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is the next step, not immediately escalating to antipsychotics. 
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