541. THE 3S OF PHARMACOLOGICAL TREATMENT FOR OCD (SRIS, SUPER-DOSES, SAFETY) – 2025 UPDATE

Abstract Background OCD stands out as a condition where serotonergic medications are the first-line treatment. Studies consistently show noradrenergic drugs, effective for depression and anxiety, are ineffective for OCD, whereas serotonergic medications are uniquely effective. Aims & Objectives SRI dosing is typically constrained by toxicity (e.g., clomipramine) or standard dose ranges proven effective for conditions like depression and anxiety. However, clinical guidelines for OCD highlight the need for higher doses. Method In a 2024 Comprehensive Psychiatry study, we assessed the safety and tolerability of "super-doses" (mega-doses) of SRIs for severe, treatment-resistant OCD. Results Results to be presented show these doses are well-tolerated, with no significant differences in side effects across 0–200 mg, 200–400 mg, and 400–600 mg of sertraline or equivalent. Discussion & Conclusions We will also discuss the medical precautions required when exceeding FDA/EMA-recommended doses and conclude with the clinical and legal implications of super-dosing in OCD treatment.