NEI Podcast E258 - The OCD Puzzle: Diagnosis, Treatment, and Innovation in Practice with Dr. Jeffrey Strawn
Jul 2, 2025
Dr. Jeffrey Strawn, a leading expert in psychiatry from the University of Cincinnati, dives deep into the nuances of obsessive-compulsive disorder (OCD) with Dr. Andy Cutler. They discuss the importance of accurate diagnoses and the misdiagnosis of OCD due to stigma. The conversation explores evidence-based treatments including SSRIs and innovative therapies like ketamine. They emphasize neuroplasticity's role in therapy and advocate for a focus on functionality in mental health treatment. The need for personalized approaches in care also shines through.
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CBT Drives Inhibitory Learning
- Exposure and response prevention in CBT creates inhibitory learning that rewires maladaptive OCD circuits.
- Patients learn anxiety can be tolerated without compulsive behaviors, leading to lasting change.
FDA-Approved SSRIs for OCD
- Fluoxetine, fluvoxamine, and sertraline are FDA-approved SSRIs for OCD down to pediatric ages.
- Paroxetine is approved only for adult OCD treatment.
Titrate SSRIs Carefully but Aim High
- Start SSRIs at low doses but aim for target higher doses relatively quickly in OCD treatment.
- Slow titration improves tolerability without sacrificing the need for effective dosing.