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SSRI response follow-up — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)SSRI response follow-upUSMLE Step 3

A 29-year-old with obsessive-compulsive disorder has taken sertraline 100 mg/day for 6 weeks. Adherence is excellent and adverse effects are mild. Compulsions have decreased by 25%, but he has not received psychotherapy. Which next step is most appropriate?

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Correct answer: E — Optimize the SSRI trial and add exposure-and-response-prevention therapy

The best answer is “Optimize the SSRI trial and add exposure-and-response-prevention therapy”. OCD often responds more slowly and at higher SSRI doses than depression. At 6 weeks with partial benefit and tolerability, the trial is not yet adequate; dose optimization and exposure-and-response prevention are preferred before declaring failure or using antipsychotic augmentation.

Reference: APA Practice Guideline for OCD: https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf