Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication Approach

A clinical guide to medication strategies for OCD, covering SSRIs, clomipramine, deep TMS, and augmentation options.

Unlock a practical OCD treatment roadmap that moves from first‑line SSRIs for OCD and Luvox (fluvoxamine) to clomipramine (Anafranil), deep TMS OCD protocols and evidence based augmentation. The episode arms clinicians with dosing pearls and tips. 💡Anti-depressant Course: psycho.farm/antidepressant-course 📖 PsychoFarm's Treating Depression Book: a.co/d/3M0uFui NAC Sheet: drive.google.com/file/d/1b7ZBeFDKAAwLhfzUo0Jv58jEL7B70l5r/vi… ================ Follow PsychoFarm: 🔴SUBSCRIBE ► youtube.com/c/Psychofarm?sub_confirmation=1 🧠Mental Health Resources: psycho.farm/services-4 ➡️Instagram: instagram.com/thepsychofarm/ ➡️Tiktok: tiktok.com/@thepsychofarm ➡️Twitter: twitter.com/ThePsychoFARM ================ 00:00 Audience Demands Pharmacology 02:00 The Problem with Biological Reductionism 08:00 General Principles 11:22 ERP First-Line 15:37 SSRIs 18:05 Switch, Raise Dose, or Augment? 19:36 Deep TMS 22:38 Antipsychotics & Clomipramine (TCA) 30:24 Glutamatergic Options (NAC, Lamotrigine, etc.) 33:31 N-acetylcysteine 39:00 Don't Join a Cult 40:12 Managing Comorbidities 49:13 Final Thoughts Obsessive compulsive disorder still frustrates clinicians, but a logical, evidence based psychiatry approach can make treatment far more effective. In this episode Dr. Greg Malzberg reviews every major step, starting with SSRIs for OCD and why many patients need higher‑than‑depression doses of sertraline or escitalopram. He then dives into the Luvox fluvoxamine versus clomipramine Anafranil debate, including when to switch and how to monitor side effects. For partial responders the discussion turns to augmentation: low‑dose Abilify or Risperidone, glutamate modulators such as N‑acetylcysteine at 2.4–3 g daily PMC , ondansetron, lamotrigine and even Buspar. Medication‑refractory cases lead to an exploration of deep TMS OCD therapy—the FDA‑cleared BrainsWay H7 coil targets the anterior cingulate and medial prefrontal cortex while pairing each session with brief ERP provocation BrainsWay . Dr. Malzberg also explains how antipsychotic augmentation can worsen compulsions if the wrong agent is chosen, outlines safe clomipramine plus fluvoxamine strategies, and offers tips for tracking Y‑BOCS scores. Expect clear talking points you can use in session tomorrow, guidelines on counseling patients about realistic (30–40 percent) symptom relief, and a reminder that exposure response prevention and moderate aerobic exercise remain foundational. Whether you are a seasoned prescriber or a learner building skills, this masterclass delivers actionable knowledge in 40 minutes.