For adults with OCD who have not responded adequately to a 12-week trial of an SSRI, consider switching to a different SSRI or to clomipramine, especially if the initial SSRI was poorly tolerated or ineffective NICE CG31.
If there has been no response after a full trial of at least one SSRI, combined treatment with CBT (including ERP) and an SSRI should be offered, or a switch to clomipramine may be considered NICE CG31.
In cases of inadequate response after 12 weeks of combined treatment with CBT and SSRI, or if there has been no response to an SSRI alone, referral to a multidisciplinary team with expertise in OCD is recommended for further assessment and treatment planning NICE CG31.
When switching medications, monitor for adverse effects and ensure gradual dose reduction to minimise withdrawal symptoms, with close follow-up during the transition NICE CKS.