A 48-year-old man with a history of obsessive-compulsive disorder, comorbid bipolar, panic disorders

When treating patients with OCD and comorbid bipolar spectrum disorder, it is important to evaluate carefully for a history of mood cycling, and to aggressively stabilize mood first. Failure to stabilize mood will inevitably undermine the long-term effects of antidepressant treatment. Second, if the patient remains treatment resistant, one option might be to switch to SNRIs, which can be helpful in addressing problems associated with impulsivity, especially if it is accompanied by attentional problems or ADD.