A 28-year-old man with obsessive-compulsive disorder has been on fluoxetine 20 mg daily for 6 weeks with minimal improvement. He continues to spend 2 hours daily on checking rituals. What is the most appropriate next step in pharmacotherapy?
- A Switch to a benzodiazepine for rapid symptom control
- B Increase the fluoxetine dose, as OCD typically requires higher SSRI doses than depression ✓
- C Add a typical antipsychotic as augmentation
- D Discontinue fluoxetine and begin cognitive behavioral therapy alone
Correct answer: B. Increase the fluoxetine dose, as OCD typically requires higher SSRI doses than depression
Explanation
OCD requires higher SSRI doses than depression, often fluoxetine 40 to 80 mg or fluvoxamine up to 300 mg, with adequate trials lasting 10 to 12 weeks. Benzodiazepines are not effective for OCD core symptoms. Antipsychotic augmentation is reserved for SSRI-refractory cases after adequate dose and duration trials.
Reference: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 11th ed.
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