For treatment-refractory OCD, the following strategies could be considered: Trial of a different SSRI Augmentation of the SSRI with an atypical antipsychotic (4 - 6) or less often lithium (7), riluzole (8), N - acetylcysteine (9, 10) Clomipramine Clomipramine (11) may be more effective and have a better response rate than SSRIs in children but not adults (12).