OCD: Did I wash my hands after I took my medication?

Pharmacotherapy for OCD:

• 1st line, on-label: fluoxetine (40-60), fluvoxamine (200), paroxetine (40-60), sertraline (200).
• 1st line, off-label: citalopram (40-60), escitalopram (20)
• NNT per Cochrane: 6-12.
• Often higher dosages (see target range above). Titrate over 4-6 weeks; treat 8-12 weeks with at least 4-6 weeks at maximal tolerable dosage. May take 10-12 weeks to notice improvement.
• Can go higher: monitor for serotonin syndrome (anxiety, tremor, tachycarida, sweating)
• Treat 1-2 years. Taper over several months.
• 2nd line: (after 2 SSRI treatment failures): clomipramine (start at 25mg), venlafaxine, mirtazapine.
• Add on therapy: atypical antispychotic including risperidone (most evidence), quetiapine, olanzapine.
• Comorbid tics: haloperidone or risperidone.