Which of the following is the first-line pharmacological treatment for Obsessive-Compulsive Disorder according to current evidence-based guidelines?

Explanation

## First-Line Pharmacotherapy for OCD **Key Point:** **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the gold-standard first-line pharmacological treatment for OCD, supported by robust evidence and international guidelines (NICE, APA, CANMAT). ### Why SSRIs Are First-Line 1. **Efficacy:** SSRIs are effective in reducing both obsessions and compulsions 2. **Safety profile:** Better tolerability than tricyclics; lower risk of anticholinergic and cardiac side effects 3. **Evidence base:** Multiple RCTs demonstrate superiority over placebo 4. **Dosing:** Higher doses required for OCD than for depression (e.g., fluoxetine 40–80 mg/day) ### Commonly Used SSRIs in OCD | SSRI | Typical OCD Dose | Notes | |------|------------------|-------| | Fluoxetine | 40–80 mg/day | FDA-approved for OCD | | Sertraline | 50–200 mg/day | FDA-approved for OCD | | Paroxetine | 40–60 mg/day | FDA-approved for OCD | | Citalopram | 20–40 mg/day | Less commonly used | **High-Yield:** OCD requires **higher SSRI doses and longer trial duration (8–12 weeks)** compared to depression treatment. This is a frequent exam point. **Clinical Pearl:** If one SSRI fails, switching to another SSRI or augmentation (e.g., with low-dose antipsychotic) is preferred over abandoning pharmacotherapy. ### Role of Other Agents - **Tricyclic antidepressants (clomipramine):** Second-line; effective but more side effects - **Benzodiazepines:** Adjunctive only for anxiety; not monotherapy; risk of dependence - **Antipsychotics:** Augmentation strategy in treatment-resistant cases, not monotherapy