If on further exploration, the symptoms are causing significant impairment or are severe, then pharmacotherapy alone or, even better, in addition to CBT should be pursued (3). Selective serotonin reuptake inhibitors (SSRIs) have established efficacy, and many are easily tolerated (1, 4). At times one must use maximal doses (for instance, 200 mg of sertraline, although some patients may respond at a dose as low as 50 mg), and a duration of 6—10 weeks is often required, although some may already show a response in 4—6 weeks. It is important to discuss duration of treatment and side effects. Even though these patients tend to obsess and may worry about unanticipated side effects or the long duration of treatment before a response is seen, surprise or worry about unanticipated side effects is most often the reason that they will discontinue treatment before it is fully effective or end treatment prematurely. Thus, as part of ongoing treatment it is best to review potential side effects as medication is begun and throughout treatment, while reassuring patients that most side effects are very rare and do not have significant risk, especially in the case of SSRIs.