Approach to managing obsessive compulsive disorder in adults and young people

Adults and young people with obsessive compulsive disorder (OCD) may be best managed by a psychiatrist. Combining psychosocial and pharmacological treatments is usually associated with the best response.

Note: Most adults and young people with OCD respond best to a combination of psychosocial and pharmacological treatment.

Psychosocial interventions are first line but some patients require initial pharmacotherapy to actively engage in psychosocial interventions. Pharmacotherapy can also be used as an adjunct to cognitive behavioural therapy (CBT) with an exposure and response prevention (ExRP) component.

When evaluating treatment options for a young person, also consider:

there are few data on psychotropic use in young people because young people are poorly represented in clinical trials
young people are more susceptible to developing activation and suicidal thoughts when starting treatment with an antidepressant; this effect has been most often observed with selective serotonin reuptake inhibitors (SSRIs)
if pharmacotherapy is used, it should ideally be started by a clinician with expertise in using psychotropics in young people.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For advice on OCD during the perinatal period, see here. For considerations in managing anxiety disorders such as OCD in partners during the perinatal period, see here.