How should I approach the management of a patient with OCD who is not responding to first-line SSRIs?

For adults with OCD who have not responded adequately to a 12-week trial of an SSRI, consider switching to a different SSRI or to clomipramine, especially if the initial SSRI was poorly tolerated or ineffective ¹.

If there has been no response after a full trial of at least one SSRI, combined treatment with CBT (including ERP) and an SSRI should be offered, or a switch to clomipramine may be considered ¹.

In cases of inadequate response after 12 weeks of combined treatment with CBT and SSRI, or if there has been no response to an SSRI alone, referral to a multidisciplinary team with expertise in OCD is recommended for further assessment and treatment planning ¹.

When switching medications, monitor for adverse effects and ensure gradual dose reduction to minimise withdrawal symptoms, with close follow-up during the transition ².