Obsessive-compulsive disorder
Chronic disorder with intrusive thoughts (obsessions) and repetitive ritual behaviors (compulsions) that substantially impair quality of life.
ICD-10 F424 drugs
Also known as: OCD
Drugs used for this condition
- AFluoxetineFirst line · Selective serotonin reuptake inhibitorsFirst-line OCD treatment. Doses above the antidepressant range are usually needed – 40–80 mg daily. Response develops more slowly than in depression: efficacy should be assessed no earlier than 8–12 weeks at an adequate dose.
- AParoxetineFirst line · Selective serotonin reuptake inhibitor (SSRI)First-line for obsessive-compulsive disorder at high doses 40–60 mg once daily. Effect at 8–12 weeks.
- ASertralineFirst line · Selective serotonin reuptake inhibitors (SSRIs)OCD requires higher doses than depression (often 150–200 mg daily). The response develops more slowly – assess at 8–12 weeks. Combination with exposure and response prevention (ERP) yields the best outcome.
- CAcetylcysteineAdd-on therapy · Mucolytic; paracetamol overdose antidote; glutathione precursorAdd-on to SSRIs in treatment-resistant OCD and conditions with shared neurobiology (trichotillomania, excoriation disorder). Evidence base is limited: small randomised trials at 2400–3000 mg/day show weak signal. NICE and AEMPS do not approve NAC for OCD; this use is off-label. The decision belongs to the psychiatrist after standard therapy fails. Before self-prescribing, consider seeking a second medical opinion.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit