“And if you don’t?” 

“I think the pipe’s going to burst.”

He’s a plumber. And he’s been fighting OCD for years.

Multiple SSRIs. High doses. CBT with your most trusted colleague across town.

And still, the rituals remain—sticky, exhausting, relentless.We talk about “treatment-resistant OCD,” but what we often mean is:

You’ve maxed out the obvious meds. You’ve done exposure therapy. And now we’re not sure what’s left.

So we stall. We switch SSRIs. We hope clomipramine works this time.

But sometimes, we don’t need more serotonin.

We need it more precisely targeted.In a recent issue of The Carlat Psychiatry Report, Dr. Kate Travis reviews a new meta-analysis on ondansetron—yes, the anti-nausea drug—as an OCD augmentation strategy.

Across 10 placebo-controlled trials, 5-HT3 antagonists like ondansetron (usually added to SSRIs) showed a 5-point drop on Y-BOCS scores.

Side effects? No worse than placebo.

We hesitate to try something unusual.

When we recommend “Zofran” for OCD, it still feels experimental, fringe—even when the data suggests otherwise.

But clinical humility means we sometimes prescribe what we weren’t trained to reach for.

Relief doesn’t always come from what’s proven.Sometimes it comes from what’s overlooked.

Join the conversation on LinkedIn with Dr. Carlat 

Related Articles

• A Clozapine Primer Author: Jonathan G. Leung, PharmD, RPh
• Repurposing Antinausea Medications for OCD Author: Kate J. Travis, MD
• Psych Meds That Cause Weight Loss? Yes, They Exist. Author: Chris Aiken, MD