Recommendation for pharmacotherapy for OCD

First lineEscitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
Second lineCitalopram, clomipramine, mirtazapine, venlafaxine XR
Third lineIV citalopram, IV clomipramine, duloxetine, phenelzine, tramadol, tranylcypromine
Adjunctive therapyFirst line: aripiprazole, risperidone
Second line: memantine, quetiapine, topiramate
Third line: amisulpride, celecoxib, citalopram, granisetron, haloperidol, IV ketamine, mirtazapine, N-acetylcysteine, olanzapine, ondansetron, pindolol, pregabalin, riluzole, ziprasidone
Not recommended: buspirone, clonazepam, lithium, morphine
Not recommendedClonazepam, clonidine, desipramine
  • IV, intravenous; XR, extended release. Reprinted from “Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders,” by Katzman et al. (2014), BMC Psychiatry, 14 Suppl 1(1), S1. CC BY 4.0.