Supra-Therapeutic Selective Serotonin Reuptake Inhibitor (Ssri) Dosesfor Refractory Obsessive-Compulsive Disorder: A Case Report


  • Syed Faraz Zafar Lahore Medical and Dental College/GTTH Lahore Pakistan
  • Michelle Ahmed Portsmouth Hospitals University United Kingdom



Obsessive-compulsive disorder (OCD), Treatment-resistant, Refractory, Selective serotonin reuptake inhibitor (SSRI), high dose


response to standard first-line treatments. We report a case of treatment-refractory OCD that was successfully treated with the pharmacological strategy of using selective serotonin reuptake inhibitors (SSRIs) in the above-licensed doses. Patient, a 26-year-old male, had failed to respond to multiple trials of SSRIs inside the licensed dose range and augmentation with antipsychotic medication when he was started on high-dose escitalopram(40mg/day). His clinical condition improved greatly after 12 weeks on this regimen, as demonstrated by a significant decrease in the Yale-Brown Obsessive Compulsive Scale (from 33 to 12). This case provides additional support to a small body of evidence that suggests the utility of using higher doses of selective serotonin reuptake inhibitors (SSRIs) in treatment-resistant obsessive-compulsive disorder (OCD).


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Stein DJ, Koen N, Fineberg N, Fontenelle LF, Matsunaga H, Osser D, et al. A 2012 evidence-based algorithm for the pharmacotherapy for obsessive-compulsive disorder. Curr Psychiatry Rep 2012 ; 14(3): 211-219.

Albert U, Marazziti D, Di Salvo G, Solia F, Rosso G, Maina G. A Systematic Review of Evidence-based Treatment Strategies for Obsessive- compulsive Disorder Resistant to first-line Pharmacotherapy. Curr Med Chem 2018; 25(41): 5647-5661.

Dold M, Aigner M, Lanzenberger R, Kasper S. Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials. Int J Neuropsychopharmacol 2013 ; 16(3): 557-574.

Fineberg NA, Hollander E, Pallanti S, Walitza S, Grünblatt E, Dell'Osso BM, et al. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders. Int Clin Psychopharmacol 2020 ; 35(4): 173-193.

Sinopoli VM, Burton CL, Kronenberg S, Arnold PD. A review of the role of serotonin system genes in obsessive-compulsive disorder. Neurosci Biobehav Rev 2017 ; 80: 372-381.

Bloch MH, McGuire J, Landeros-Weisenberger A, Leckman JF, Pittenger C. Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Mol Psychiatry 2010 ; 15(8): 850-855.

Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry 2007 ;164(7 Suppl):5-53.

Pampaloni I, Sivakumaran T, Hawley CJ, Al Allaq A, Farrow J, Nelson S, et al. High-dose selective serotonin reuptake inhibitors in OCD: a systematic retrospective case notes survey. J Psychopharmacol 2010; 24(10): 1439-1445.

Kayser RR. Pharmacotherapy for Treatment-Resistant Obsessive-Compulsive Disorder. J Clin Psychiatry 2020 ; 81(5): 19ac13182.




How to Cite

Zafar SF, Michelle Ahmed. Supra-Therapeutic Selective Serotonin Reuptake Inhibitor (Ssri) Dosesfor Refractory Obsessive-Compulsive Disorder: A Case Report. Pak Armed Forces Med J [Internet]. 2024 Apr. 29 [cited 2024 May 24];74(2):591-3. Available from:



Case Reports