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Treatment of obsessive-compulsive disorder and body dysmorphic disorder
Please refer to for full information NICE CG31: Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD)
SSRIs
If SSRI prescribed, use in combination with concurrent CBT (including ERP), if unable to engage make specific arrangements for careful monitoring for adverse effect and record in notes.
SSRIs should only be used after assessment and diagnosis by a child/adolescent psychiatrist who should be involved in decisions about dose changes and discontinuation.
Use low starting dose, especially for young children (consider quarter or half normal starting dose in week one)
Obsessive Compulsive Disorder – use licensed medication:
- Sertraline (licensed for children older than 6 years)
Obsessive Compulsive Disorder plus significant co-morbid depression
- Fluoxetine
Body Dysmorphic Disorder
- Fluoxetine
Monitoring for patients starting on SSRIs
Careful and frequent monitoring required. Agree arrangements and record in the notes.
Inform the patient and their family/carers about the possibility of the following at the start of treatment:
- Suicidal behaviour
- Self-harm
- Hostility
Advise the patient's family to make urgent contact with the medical practitioner if new symptoms such as these develop.
If significant co-morbid depression, monitor specifically for suicidal thoughts or behaviours.
Non-responsive to any treatment
Be aware of co-morbid conditions, learning disorders, persisting psychosocial risk factors (e.g. family discord), and parental mental health problems.
- Consider alternative/additional interventions for these patients
- Evidence-based treatment is still required
Drugs not recommended for OCD or BDD
The following should not be used:
- Tricyclic antidepressants (except clomipramine)
- Other antidepressants (SNRIs, MAOIs)
- Antipsychotics alone for routine treatment (may be considered as augmentation strategy)
Treatments such as combined antidepressant and antipsychotic augmentation should not be routinely initiated in primary care.
