Remission of treatment-resistant obsessive-compulsive disorder with 600 milligrams of fluvoxamine daily: a case report

Abstract

First-line drugs for obsessive-compulsive disorder (OCD) pharmacotherapy are selective serotonin reuptake inhibitors (SSRI). The medication must be continued for at least 12 weeks at an effective dosage to find the most effective SSRI. For treatment, the drug dose should be titrated to the highest tolerated dose. The manufacturer's recommended maximum dose of fluvoxamine is 300 mg per day. We reported remission after about 1 month of 600 mg (high dose) fluvoxamine, which was tolerated by a patient with OCD. The patient continued at this dose for 3 months and remained in remission. Int Clin

Debated issues in major psychoses

“…However, the maximum dose reported in the drug label is frequently a barrier and the use of off label, high doses is debated. A paper in this issue reports a favorable outcome of a case with a resistant obsessive compulsive disorder treated with 600 mg/day of fluvoxamine, that is, double the maximum recommended dose in the summary of product characteristics (Kocamer Şahin et al ., 2023). The patient initially took such a high dose by mistake, but the observed benefit in the absence of relevant side effects convinced the clinician to continue the high dose of 600 mg for 1 month, with then a cautionary reduction to 450 mg with adjunctive psychotherapy for safety concerns, but with a persisting low obsessive symptomatology.…”