An adequate therapeutic trial of any agent must be completed before changing agents or augmenting. For clomipramine, an adequate trail consists of a dose of 250 mg/d for 10 to 12 weeks.2,3 Sertraline is effective for OCD and would be an appropriate choice if the patient does not respond to or cannot tolerate an adequate trial of clomipramine. Lithium, trazodone, and tricyclic antidepressants other than clomipramine have generally not been found to be effective for OCD.2,3
- Gradually titrate clomipramine to 250 mg/d and continue the trial.
2. Hollander E, Simeon D. Anxiety disorders. In: Hales RE, Yudofsky, editors. Textbook of clinical psychiatry. Washington (DC): American Psychiatric Publishing; 2003:543-630.
3. Janicak PG, Davis JM, Preskorn SH, Ayd FJ. Assessment and treatment of other disorders. In: Principles and practice of psychopharmacotherapy. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001:523-58.
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