Dose-Dependent Urinary Incontinence with Sertraline Use in Obsessive-Compulsive Disorder

Ms. K is a 34-year-old female, gravida 1, para 1 (G1P1001) with a psychiatric history of major depressive disorder, previously managed with bupropion in her early 20s. Following delivery of her child, she developed symptoms of generalized anxiety disorder with panic attacks. Ms. K subsequently developed intrusive thoughts related to the health and well-being of her child, that morphed into intrusive, unwanted thoughts about aggression and harm towards her baby and began avoiding contact with her infant due to fear and guilt. Bupropion was restarted by her primary care clinician, due to her past response, but was only mildly helpful. She was referred to Psychiatry and diagnosed with obsessive compulsive disorder (OCD). Patient Health Questionnaire-9 (PHQ-9) screening score was 11 and Generalized Anxiety Disorder-7 (GAD-7) screening score was 13 at her initial visit. Bupropion was discontinued in favor of sertraline and addition of cognitive behavioral therapy (CBT) with an exposure response prevention (ERP) approach was also recommended.