SSRIs are the drug of choice for many conditions. That is true of both obsessive-compulsive disorder and depression (excellent board exam nugget to remember). As you are reviewing a patient’s medication list or potentially helping with that patient’s pharmacotherapy, there can be a significant difference in the dosing of SSRIs in OCD versus depression. You will often (not always) notice that if a patient is on a higher-than-usual SSRI dose, we may be treating OCD versus depression.
In OCD, the target dosages of SSRIs are generally higher than for depression. Let’s take fluoxetine, for example. When treating depression, the usual dosages I see in practice are in the range of 20-40 mg per day. In the treatment of OCD, we will often push that upwards of 80 mg per day if the patient is not responding. Now, if the patient does respond at a lower dose and is doing well clinically, we may leave it at that lower dose.
One more example just to illustrate my point. Sertraline antidepressant dosing is usually in the range of 50-150 mg per day. With OCD, that may be pushed closer to 200 mg per day or even higher in some cases, as long as it is tolerable at these higher dosages.
So next time you see a higher than usual dose of an SSRI, take a look at the diagnosis, as it may be used for OCD.
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