# Obsessive-compulsive disorder (OCD referral pathway) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501) · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552) - Verified date: 2026-08 ## Verified against - Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501) - Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) - Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552) - Obsessive-Compulsive Disorder - disease-level clinical article (obsessive-compulsive-disorder-referral-clinical.txt) ## Treatment metadata - Fluoxetine — 20 mg — oral.solid - Sertraline — 50 mg — oral.solid - Referral & safety-netting (no drug therapy) - Clomipramine — 25 mg — oral.solid ## Complete treatment card ```text OBSESSIVE-COMPULSIVE DISORDER (OCD REFERRAL PATHWAY) Sources: Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501) · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552) Review status: REVIEWED against Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501), Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909), Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552), Obsessive-Compulsive Disorder - disease-level clinical article (obsessive-compulsive-disorder- referral-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Obsessions are recurrent, intrusive, unwanted thoughts or images causing marked anxiety [anxiety] - Compulsions are repetitive acts performed to ease distress or head off a feared event - Symptoms must take up at least 1 hour a day and disrupt daily life to meet diagnostic criteria - Fear of causing harm with compulsive checking is a common symptom cluster - Aggressive, sexual, or religious obsessions with matching rituals suggest a worse outlook - New mothers may have distressing thoughts of harming the baby and hide them out of fear of judgment SIGNS - what you find (4) - Patients appear well-groomed but visibly anxious, with washing or checking behaviors seen in the interview [anxiety] - Repetitive tapping, checking, or washing is seen even though it visibly distresses the patient - Hallucinations or illusions are rarely seen in OCD, unlike some other psychiatric conditions [hallucinations] - Insight is usually preserved - patients see their obsessions as irrational but feel unable to stop them TESTS (2) - A short 6-question OCD screener carries a sensitivity of 97% - The Y-BOCS scale scores severity from 0 to 40, with 40 being most severe IF NOT THIS - what else fits (11) - Generalized anxiety disorder involves real-life worries without compulsions, unlike OCD - Specific phobia fears are limited to a particular object or situation, without rituals - Social anxiety disorder's avoidance targets social fear rather than neutralizing an obsession - Major depressive disorder's ruminations are mood-congruent, not linked to compulsions like OCD's - Body dysmorphic disorder's obsessions and compulsions are limited to appearance - Trichotillomania is compulsive hair-pulling without accompanying obsessions - Hoarding driven by OCD-like obsessions is diagnosed as OCD instead of hoarding disorder - Eating-disorder rituals are focused specifically on weight and food - Tics are simpler, stereotyped movements not meant to neutralize an obsession - Psychotic disorders bring true hallucinations, which OCD patients do not have despite sometimes poor insight - OCPD is a rigid perfectionism pattern seen as rational by the person, without true obsessions or compulsions Source StatPearls "Obsessive-Compulsive Disorder" - disease-level clinical article Status traced to the source above 1. FLUOXETINE [1st line] Adult 20 mg once daily initially; if after 2 weeks response is insufficient, dose may be increased gradually up to a maximum of 60 mg daily Peds FLUOXETINE should only be used in children and adolescents aged 8 to 18 years for the treatment of moderate to severe major depressive episodes and it should not be used in other indications. Source Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) Why Higher SSRI doses are routinely required for OCD compared to depression Caution Onset of therapeutic effect in OCD takes 8-12 weeks at maximum tolerated dose. Fluoxetine has a long half-life (the active metabolite norfluoxetine persists for weeks after stopping). Agitation, insomnia, GI upset, and sexual dysfunction are common. Contraindicated in combination with irreversible, non-selective monoamine oxidase inhibitors. Fluoxetine is contra-indicated in combination with irreversible, non-selective monoamine oxidase inhibitors. Egypt FLOROSIN 20MG 10 CAPS. UP PHARMA 11.00 EGP (1.10/unit) PHILOZAC 20MG 10 CAPS. AMOUN 11.00 EGP (1.10/unit) FLUOXETINE 20 MG 10 CAPS. MISR 18.60 EGP (1.86/unit) ELEVAMOOD 20 MG 28 CAPS. UNIPHARMA 56.00 EGP (2.00/unit) OCTOZAC 20MG 10 CAPS. OCTOBER PHARMA 21.60 EGP (2.16/unit) PHILOZAC 20MG 30 CAPS. AMOUN 75.00 EGP (2.50/unit) PROZAC 20MG 14 CAPS. ELI LILLY 118.00 EGP (8.43/unit) FLUOXETINE 20 MG H.G.CAPS. SIGMA 8.00 EGP 2. SERTRALINE [1st line] Adult 50 mg once daily initially, titrate by 50 mg steps every 2-4 weeks up to 200 mg once daily Peds 6 to 12 years: 25 mg once daily to start 13 to 17 years: 50 mg once daily to start (Age 13-17 years: Initially 50 mg once daily. Age 6-12 years: Initially 25 mg once daily.) Choice Alternatives, both first-line SSRIs for obsessive-compulsive disorder. Sertraline is chosen for consistency with the other SSRI entries; both need higher doses here than in depression. Source Sertraline 50 mg film-coated tablets SmPC section 4.2 (eMC product 3501) Why SSRI that increases synaptic serotonin availability; first-line pharmacotherapy for OCD symptoms while specialist referral is arranged. Caution Monitor for increased agitation and suicidal ideation early in treatment. Taper off gradually when discontinuing. Diarrhea and nausea are common early side effects. Never stopped abruptly - come down over at least one to two weeks or withdrawal follows. Watch sodium in the elderly. SSRI hyponatraemia is easy to miss and presents as confusion or a fall. Concomitant treatment with irreversible monoamine oxidase inhibitors (MAOIs) is contraindicated. Egypt OPIRALINE 50 MG 20 F.C. TABS. EL-OBOUR 29.00 EGP (1.45/unit) AGRELOCIT 50 MG 20 TAB. MEMPHIS > ATM... 34.80 EGP (1.74/unit) DEPR-STAT 50MG 10 CAPS. MEMPHIS 21.60 EGP (2.16/unit) SESERINE 50MG 30 TAB. ADWIA 75.00 EGP (2.50/unit) SERPASS 50MG 30 F.C.TAB. GLOBAL NAPI P... 102.00 EGP (3.40/unit) SIRTO 50MG 10 F.C. TABS. HI-PHARM 34.00 EGP (3.40/unit) MOODAPEX 50 MG 30 F.C.TAB. MULTI-APEX 111.00 EGP (3.70/unit) LUSTRAL 50 MG 20 F.C.TABS. VIATRIS 136.00 EGP (6.80/unit) 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Obsessive-Compulsive Disorder - disease-level clinical article (obsessive-compulsive- disorder-referral-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Suicide risk assessment: OCD is significantly associated with suicidal tendencies, particularly with comorbid anxiety/depression or a prior suicide attempt. RED FLAG - Carry out a safety assessment for immediate risk to the patient or others, including vigilance for postpartum OCD with intrusive thoughts of harming the baby. 4. CLOMIPRAMINE [2nd line] Adult 25 mg at bedtime initially, titrate gradually over 2-3 weeks to 100-150 mg daily (max 250 mg daily) Peds Not recommended in children and adolescents (0 to 17 years) (safety and efficacy not established). Source Clomipramine 10 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 2552) Why Potent serotonergic TCA reserved for SSRI-resistant OCD due to higher side effect burden Caution Cardiotoxic in overdose (QTc prolongation, arrhythmias, heart block); baseline ECG required. Severe anticholinergic effects, sedation, and a lowered seizure threshold can occur. Avoid co-administration with MAOIs or other QTc-prolonging drugs. Egypt ANAPRAMINE 25 MG 30 F.C.TAB. SIGMA 31.50 EGP (1.05/unit) ANAFRONIL 25 MG 30 TAB. NOVARTIS > SA... 66.00 EGP (2.20/unit) SUPRANIL 25 MG 30 CAPS. ALFACURE PHAR... 66.00 EGP (2.20/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)