First-line pharmacologic treatments consist of 5-HT reuptake inhibitors such as the SSRIs, and clomipramine, a tricyclic antidepressant (TCA). Possible alternatives include venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI).
Behavior therapy is a first-line treatment and should be undertaken with a psychotherapist who has specific training and experience in OCD treatment. Patients who have achieved remission of symptoms with behavior therapy alone may never require medication.
Patients can also be treated using a combined approach. If they achieve remission, they may continue with behavioral interventions alone when required. However, many patients require ongoing medication to prevent relapse.
Treatment is usually done in an outpatient setting. People with severe OCD are at high risk for suicide, and hospitalization should be considered if a suicide risk exists or if symptoms are severe enough to impair patients' ability to care for themselves at home.