Psychofarm Podcast Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication Approach
Aug 5, 2025
Discover the intricacies of treating OCD with a focus on medication strategies like SSRIs, clomipramine, and the promising role of N-acetylcysteine. Learn about the significance of exposure response prevention and how alternative approaches like TMS can aid in symptom management. The discussion delves into the complexities of OCD diagnosis and the potential pitfalls of treatment, emphasizing personalized care. Unpack the fascinating role of the Sigma-1 receptor in medication effectiveness and explore new therapeutic methods to enhance patient outcomes.
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Medication Trial Expectations
- Continue medication about one year after start and expect trials to take ~8 weeks per dose.
- Aim for symptom reduction of ~30–40% and use Y-BOCS to track progress.
Prioritize ERP Over Meds
- Use ERP first; meds only if symptoms severe or patient won't engage in therapy.
- Don't mistake medication for treatment; meds facilitate therapy.
First-Line SSRI Choices
- Start with an SSRI like sertraline or escitalopram and avoid paroxetine due to weight gain.
- Consider switching to fluvoxamine (Luvox) if initial SSRIs fail.