OCD therapy reference (2026)

OCD therapy in 2026 organises around three tiers.

First-line: cognitive-behavioural therapy with exposure and response prevention (CBT-ERP) is the most-evidenced psychotherapy. SSRIs (typically at higher doses than for depression) and clomipramine are the first-line pharmacotherapy options, often combined with CBT-ERP. Response generally takes 8 to 12 weeks at adequate dose.

Augmentation and second-line: low-dose atypical antipsychotic augmentation (risperidone, aripiprazole) for partial responders. Switching to a different SSRI or clomipramine if first SSRI fails.

Procedural and emerging: transcranial magnetic stimulation (deep TMS) has approval for OCD and growing real-world use. Deep brain stimulation has approval for refractory OCD; centres of excellence with specialist OCD-care infrastructure are required. Glutamate-modulator programs (troriluzole and others) are in late-stage trials. Psychedelic-assisted therapy programs in OCD are in earlier-stage trials.

The specialist-care infrastructure question matters. CBT-ERP delivered by specialty-trained therapists, refractory-OCD specialist evaluation, and procedural-OCD centres are concentrated rather than uniformly available.