Efficacy of Supratherapeutic Duloxetine Combined With Cognitive-Behavioral Therapy in Severe Treatment-Resistant Obsessive-Compulsive Disorder With Comorbid Depression: A Case Report

This case report discusses the treatment of a 42-year-old male with over a decade of treatment-resistant obsessive-compulsive disorder (OCD) and comorbid major depressive disorder (MDD). The patient underwent various pharmacological and psychotherapeutic treatments, including multiple antidepressants and cognitive-behavioral therapy (CBT), yet experienced only partial symptom relief. At baseline, the patient's depressive symptoms were severe, with a Hamilton Depression Rating Scale (HAM-D) score of 28, and his obsessive-compulsive symptoms were marked, with a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 34. Due to the chronicity and severity of symptoms, his treatment plan was adjusted to include a high dose of duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), which was gradually titrated to 180 mg/day with close monitoring. Within weeks of this dose adjustment, the patient experienced significant improvements in both depressive and obsessive-compulsive symptoms. The patient sustained these improvements over six months, reporting enhanced functional capacity and quality of life with minimal side effects, with his HAM-D and Y-BOCS scores reduced to 8 and 12, respectively. This case highlights the potential benefits of high-dose duloxetine in complex, treatment-resistant cases and underscores the value of combining pharmacotherapy with CBT to achieve durable outcomes. The report adds to emerging evidence suggesting that supratherapeutic dosing of SNRIs may be a valuable option for patients unresponsive to standard treatments. Further research is encouraged to evaluate the broader applicability and safety of this approach.