A 45-year-old man presents to your clinic for follow-up regarding his obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a chronic and often relapsing condition. MCCQE objectives emphasize that patients with severe OCD requiring hospitalization or prolonged high-dose SSRI therapy are at significant risk of relapse if medication is discontinued. This patient has remained stable for 2 years on a high dose of paroxetine after inpatient treatment, suggesting a history of more severe disease.

For moderate-to-severe or recurrent OCD, long-term or indefinite maintenance pharmacotherapy is often recommended, particularly when the patient has responded well and tolerated the medication. Abrupt discontinuation or large dose reductions (e.g., 50%) increase the risk of relapse and discontinuation syndrome, especially with paroxetine, which has a short half-life. Switching to another SSRI is unnecessary when the current medication is effective and tolerated. Supportive psychotherapy alone is generally insufficient for patients with previously severe OCD.

Therefore, the most appropriate recommendation is to maintain the current dosage , while discussing risks and benefits and reassessing periodically.