How do you manage obsessive-compulsive disorder refractory to high-dose SSRI and cognitive behavioral therapy?  

First, I would ask what "high dose" is being used. High doses for some are regular doses for others. This would be, of course, after verifying that the patient has been taking the medication regularly and as prescribed. Second, I would ask what the duration of the current regimen of medications h...

In general, I follow a decision tree based on refractoriness and comorbid conditions. Let us first assume that we have already provided an adequate dose of an SSRI for an adequate duration of 12 weeks. I use the following doses as general targets for SSRI treatment: Fluoxetine 80 mg/d Escitalop...