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Clomipramine-resistant, fluoxetine-responsive obsessive compulsive disorder: a case report.

Serotonin re-uptake inhibitors (SRIs), clomipramine and selective serotonin re-uptake inhibitors (SSRIs), are the first-line pharmacologic therapies for patients with obsessive compulsive disorder (OCD). However, 40 to 60 per cent of patients do not respond to adequate treatment trials of SRIs. SRI partial- and non-responders must be treated with augmentation strategies or put on another SRI since non-response to the first SRI does not necessarily indicate a non-response to a second SRI. Each treatment trial should run at least 10 weeks and if successful, the drug should be continued for at least 1 to 2 years and withdrawn gradually. The presented patient had a second episode of OCD which was resistant to more than 10 weeks of high dosage clomipramine even though he responded very well during the first episode 4 years earlier and had been off clomipramine for 3 years. Augmentation to clomipramine with lithium and then haloperidol consecutively also failed. When clomipramine was changed to fluoxetine, the OCD symptoms were responsive even at a starting dosage of 20 mg/day. The response improved as the dosage of fluoxetine was increased. The response reached a maximum and the patient coped very well in every aspect of daily life when the dosage of fluoxetine was increased to 60 mg/day. He had taken fluoxetine at this daily dosage for one year before the drug was tapered off. It has now been more than two years since he has had any OCD symptoms and clomipramine was terminated.