Katharine Phillips, MD (bio), is internationally-recognized as an expert on body dysmorphic disorder and related disorders like obsessive-compulsive disorder (OCD).
She was interviewed by Rajnish (“Raj”) Mago, MD, Editor-in-Chief of Simple and Practical Mental Education, LLC, on October 18, 2019.
Part one: SSRIs for OCD: Which one, how much, and for how long?
In this part, Dr. Phillips answers the following questions (including those sent in by Members of Simple and Practical Medical Education, LLC):
– Is one of the six SSRIs more effective for OCD than the others?
– How should we choose among the SSRIs? What are the reasons to prefer some of them? Which ONE of the SSRIs does she NOT prescribe?
– How does she dose the SSRIs for OCD? After how long does she increase the dose and how high does she go for each one of them?
– Is there research evidence that higher than FDA-approved doses of SSRIs can work for OCD when lower doses have not worked?
– How long should we try an SSRI for OCD before concluding that it did not work?
Part two. Next steps: Antipsychotic augmentation, clomipramine
In this part, Dr. Phillips answers the following questions (including those sent in by Members of Simple and Practical Medical Education, LLC):
– What are some ways to help to help patients to tolerate the SSRI?
– What should we do if an SSRI alone does not work?
– Which antipsychotics are best established as augmentation agents for OCD?
– Is it better to add an antipsychotic or to switch to clomipramine?
– When is she more likely to add an antipsychotic to the SSRI?
– Is clomipramine more effective than the SSRIs?
– Should we add clomipramine to an SSRI or switch to clomipramine?
– How does she start and titrate clomipramine?
– What monitoring should be done if clomipramine is prescribed? When and how often?
Part three
In this part, Dr. Phillips answers the following questions (including those sent in by Members of Simple and Practical Medical Education, LLC). Is there a role for the following agents in difficult-to-treat OCD?
– N-acetylcysteine (NAC)?
– Transcranial magnetic stimulation (TMS)?
– Memantine? Riluzole? Lamotrigine?
– Tramadol?
– Electroconvulsive therapy (ECT)?
Related Pages
Obsessive-compulsive disorder (OCD): Interview with Elna Yadin, PhD
SSRIs for OCD
Higher than usual doses of SSRIs for OCD?
Clomipramine versus SSRIs for OCD
Add clomipramine to an SSRI for OCD?
Concerns about combining clomipramine and SSRIs
How exactly to add clomipramine to an SSRI
When and how to check the clomipramine level
How to interpret clomipramine and desmethylclomipramine levels
OCD: Second-line medications
Antipsychotic “augmentation” for OCD
Is fluvoxamine more effective for OCD than other SSRIs?
N-acetylcysteine (NAC) for obsessive-compulsive disorder (OCD)?
OCD: Prognosis
BEST books about OCD for patients and families
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