Obsessive-compulsive disorder (OCD) involves obsessive thoughts and compulsive behaviors. Treatment for OCD can include medication and therapy. There are several different types of medications that are effective for treating OCD, but SSRIs are typically preferred because they are safe and effective. People with OCD who are taking medication can expect to notice improvements in around 8 to 12 weeks.
What Is OCD?
Obsessive compulsive disorder (OCD) is a mental health diagnosis involving intrusive thoughts, called obsessions, that cause them severe distress. These thoughts lead people to act on specific rituals, called compulsions, that temporarily relieve their anxiety. However, the cycle continues endlessly and takes up a lot of the person’s time and attention.
How Is OCD Diagnosed?
OCD is diagnosed by a psychiatrist with the help of a therapist. Over time, the therapist and psychiatrist will learn more about a person’s current symptoms and history to come to a diagnosis. They do this by considering the recurrence of repetitive behaviors and the negative impact of these behaviors on one’s life.
Why Use Medication for OCD?
Medication is often recommended as a treatment for OCD.1 Some people with mild OCD may be able to recover with therapy alone, but if symptoms are moderate to severe, then treatment usually includes both therapy and medication. If your symptoms of OCD are interfering with your life, causing you distress, and not improving with just therapy, then you may want to consider whether medication may be right for you.
How to Get OCD Medication
If you are thinking about medication for OCD, you can start by speaking with your physician or seeking a consultation with a psychiatrist or psychiatric nurse practitioner who has specific experience in treating OCD. Depending on your insurance, you might need a referral to meet with one. They will be able to set up an evaluation where they will ask you several questions about your symptoms and history to help determine whether you could benefit from medication for your OCD. If they feel like medication is right for you, they will provide you with a prescription and discuss how often and how much you should take, as well as any potential side effects.
What Are the Most Common OCD Medications?
The most common medications for OCD are SSRIs, as they are typically safe and effective, with relatively few side effects.
Common medications used to treat OCD include:
Fluoxetine (Prozac)
Fluoxetine, or Prozac, is a selective serotonin reuptake inhibitor (SSRI), which is a commonly prescribed antidepressant that also affects serotonin levels in the brain, but has a lower risk for harmful side effects.2,3 Doctors may prescribe Prozac for OCD as an FDA-approved treatment for in children seven years and older
Paroxetine (Paxil, Pexeva)
Paroxetine, also sold under the brand names Paxil and Pexeva, is another type of SSRI that is used to treat OCD.2,5 Doses of up to 100mg of paroxetine may be needed to manage OCD symptoms.
Fluvoxamine (Luvox)
Fluvoxamine was the first SSRI shown to be effective for the treatment of OCD.2,6 It is FDA-approved for adults and children over eight years old. Doses of up to 300 mg may be prescribed to help alleviate OCD symptoms. Prescribers tend to avoid prescribing fluvoxamine with clomipramine, because these medications together can increase the risk of seizures and arrhythmia.
Sertraline (Zoloft)
Zoloft, which is also available as the generic sertraline, is another SSRI that is approved for treating OCD in people ages six and older.7,8 Like other SSRIs, using Zoloft for OCD is considered generally safe, but it can cause certain side effects.
Clomipramine (Anafranil)
Tricyclic antidepressants like clomipramine work on the serotonin receptors in the brain.2,3 This medication has been used since the 1980s as a treatment for OCD and is considered effective for adults and children over 10 years old. However, clomipramine can cause certain side effects, like drowsiness, dry mouth, nausea, vomiting, increased heart rate, and weight gain. These side effects are more likely at high doses of 250mg or more.
Because of the potential for developing these side effects, providers are cautious in prescribing this medication. If you are prescribed clomipramine, your provider will discuss the possibility of side effects and closely monitor you.
Off-Label Medications for OCD
There are several off-label medications that a psychiatrist or other provider may prescribe for the treatment of OCD. This means that these medications were not designed to treat OCD, however they have significant secondary gains for treating OCD and have been proven to help reduce OCD symptoms.
Citalopram (Celexa)
Celexa, also known by the generic citalopram, is an SSRI.2 While it is not FDA-approved for the treatment of OCD, studies have shown that it is effective for alleviating symptoms of OCD and some providers will prescribe it off-label for this purpose.
In 2011, the FDA issued a black-box warning for doses of Celexa that are over 40mg because of the risk of developing arrhythmias and ECG abnormalities. Because of the potential risks, prescribers always weigh the pros and cons before prescribing this medication to determine whether it is best for the patient.
Venlafaxine (Effexor)
Effexor is an SNRI originally used to treat depression and some types of anxiety. It has also been effective in the treatment of OCD-related anxiety symptoms.
Escitalopram (Lexapro)
Lexapro is an SSRI used to treat depression and general anxiety. Some prescribers use Lexapro for OCD as an off-label treatment because it has been shown to help reduce the obsessive thinking and fixation-related anxiety that comes with OCD.
Other Medications Sometimes to Treat for OCD Symptoms
When the above medications do not work or are contraindicated, a provider may prescribe a benzodiazepine or antipsychotic to help reduce the anxiety that comes with OCD.
Benzodiazepines
Benzodiazepines may be used when other treatment options do not work and are only prescribed very carefully, as they can sometimes interfere with the effectiveness of exposure and response prevention therapy. Benzodiazepines would be given to help reduce the anxiety-related symptoms of OCD such as obsessive thoughts or repetitive behaviors.
Benzodiazepines include:
- alprazolam (Xanax)
- clonazepam (Klonopin)
- diazepam (Valium)
- lorazepam (Ativan)
- midazolam (Versed)
Antipsychotics
When SSRIs, SNRIs, and benzodiazepines do not work for treating OCD, a provider may consider an antipsychotic to help reduce certain behaviors.
- Aripiprazole (Abilify)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
Side Effects of OCD Medications
Side effects are common when taking medications. When it comes to OCD medications, SSRIs typically cause the fewest and least severe side effects.2 Clomipramine, on the other hand, can cause anticholinergic side effects, which can include dry mouth and constipation. The types of side effects can vary from person to person. Be sure to discuss any side effects you experience with your provider.
Common side effects of OCD medication include:3,4,5,6,7,8
- Anxiety
- Changes in sleep
- Unusual dreams
- Dry mouth
- Nausea
- Diarrhea
- Constipation
- Heartburn
- Yawning
- Shaking
- Fatigue
- Sensitivity to light
- Decreased appetite
- Weight gain or loss
- Loss of sexual drive
- Sweating
- Headaches
- Forgetfulness
- Difficulty concentrating
Severe Side Effects
Seek professional help if medication causes you to experience the following:3,4,5,6,7,8
- Rash
- Swelling
- Excessive bleeding or bruising
- Uncontrollable shaking
- Increased heart rate
- Muscle stiffness
- Urinary problems
- Breathing problems
- Fever
- Extreme fatigue
- Hallucinations (seeing or hearing things that are not there)
- Seizures
SSRIs & Suicidal Thoughts
Be aware, medications within the SSRI drug class and tricyclic antidepressants have a black box warning. These are the most serious type of warnings from the Food and Drug Administration (FDA). SSRIs can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of age, you should talk with your doctor about severe risks with SSRIs and other medications before starting treatment.
What’s the Best Medication for OCD?
It’s hard to say what the “best” medication is for OCD, because what is best for one person may not be best for another. Each person responds to medication differently. However, SSRIs like paroxetine and fluoxetine are often recommended first because they are considered safe and effective with a low risk for serious side effects.2 If a person does not improve on an SSRI, a prescriber may then decide to try a different type of medication like clomipramine.
What Kind of Doctor Should I Look For to Prescribe OCD Medications?
If you are looking for a specific mental health medication, it is important to go to a psychiatrist. Psychiatrists are trained in this area and better equipped to know which medications would be beneficial. If you are looking for OCD treatment specifically, it is important to talk to your doctor (and anyone else on your care team) about their experience with OCD.
Which OCD Medication Should Someone Try First?
Before you begin or end any medication, it is important to have a conversation with your doctor and/or your psychiatrist. Many providers begin with an SSRI as they are the front-line medication of choice for OCD treatment.
Are OCD Medications Effective?
SSRIs are effective in treating OCD.2 Since the 1980s, over 20 studies have found SSRI monotherapy, or treatment with one medication, to be effective. These medications are often preferred over other OCD medications like clomipramine, because they are less likely to cause side effects.
When it comes to SSRIs, there is no evidence that one works better than another. However, higher doses than those typically prescribed for depression are needed to treat OCD. The choice of what medication to prescribe will depend on a person’s symptoms, risk of side effects, interactions with other medications, and personal preference.
How Long Do They Take to Work?
SSRIs typically take 8 to 12 weeks to help manage OCD symptoms.1,2 This is longer than it usually takes SSRIs to improve symptoms of depression. In the meantime, therapy can help a person address their OCD until they are able to experience the full benefits of medication.
Should I Stop Taking Medication Once I Feel Better?
Often, people are inspired to stop their medication once their symptoms alleviate. A person should always take their medication and only adjust their dose or frequency after consulting with their prescriber. Medications usually need to be used consistently to maintain their benefit. In some situations, stopping a medication abruptly can cause OCD symptoms to worsen or create unwanted new symptoms.
Risks of OCD Medication
SSRIs like Zoloft, Prozac, and Paxil are typically the first medications recommended for OCD.2 These medications are considered to be generally safe. However, one risk to be aware of when taking SSRIs is the possibility of developing suicidal thoughts.11 Some studies have found an increased risk of suicidality in teens and young adults on antidepressants. Though this is rare, it’s important to be aware of this risk. If you find yourself experiencing suicidal thoughts, take action by contacting 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
In many cases the benefits of medications outweigh any potential risks, but your psychiatrist will discuss this with you. If you have any concerns, don’t hesitate to ask your prescriber.
Who Should NOT Take Medication for OCD?
For most people, the medications prescribed for OCD are safe and effective. Still, some people should not take certain medications for OCD:
- People who experience severe side effects: Side effects may vary between medications, but for someone who has intense side effects, medications may not be best.
- People who are pregnant or breastfeeding: Based on their symptoms and status certain medications can still be given, but prescribers should take extra caution. The potential risks and benefits must be weighed carefully.
- People with heart conditions: Some medications can create or worsen heart conditions. Be sure to discuss all health issues with the prescriber before beginning a new medication.
- Older people: Medications for OCD may trigger thinking problems and confusion, which may be especially problematic in older people.
This is not a complete list of precautions for taking medications for OCD. You should talk with your doctor about your health history and your treatment goals to determine the safest medication for you.
What to Consider If You’re Pregnant or Breastfeeding
If you’re pregnant or trying to become pregnant, you may be wondering if it’s safe to take medication for OCD. SSRIs are generally considered safe for pregnant women, but these medications do cross the placental barrier to the fetus.12 Birth defects are rare but can occur.
Some babies exposed to SSRIs in utero develop withdrawal symptoms like irritability, low blood sugar, and feeding difficulties. These symptoms usually resolve rather quickly and do not harm the baby. However, more research is needed to fully understand how medications during pregnancy can affect children’s future development.
What to Consider If You’re Taking Other Medications
Depending upon the specific medication, some OCD medications may interact with other medications, which could have harmful results. For example, fluvoxamine and clomipramine are rarely prescribed together because taking them at the same time can increase the risk of seizures and arrhythmia.2
Questions to Ask Your Prescriber About OCD Medication
If you’re considering medication for OCD, then you likely have questions for your prescriber. You will want to know about how to take these medications, what to watch out for, and whether you should make any lifestyle changes. Consider writing a list of questions and bringing it with you to your appointment.
These questions may be helpful to ask your doctor/prescriber before taking a new OCD medication:
- How much and how often should I take this medication?
- What should I do if I miss a dose?
- Should I avoid certain foods or substances like alcohol or caffeine?
- Are there any side effects that I should be aware of?
- Is it dangerous to mix this medication with any other medications or supplements?
- What should I do if I am experiencing side effects?
Other Treatments for OCD Often Combined With Medication
Therapy is another form of treatment that is recommended for OCD.9 Some people choose to start with therapy and later add medication if their symptoms don’t improve. Others may start off with therapy and medication right away. Medication is almost always recommended in conjunction with therapy to achieve the best effects.
The most common and effective type of therapy for OCD is exposure and response prevention (ERP), a technique that is effective for treating OCD in children, teens, and adults.9 The goal of ERP is to cope with obsessive thoughts without turning to compulsive behaviors.
ERP involves the following steps:10
- Providing education on OCD
- Identifying triggers for anxiety and obsessive thoughts
- Teaching how to rate anxiety on a scale from 0 to 100
- Creating a hierarchy of fears
- Developing skills to cope with anxiety without using rituals
- Exposing the person to anxiety and obsessive thoughts and helping them use coping skills to manage
A trained therapist will guide you through these steps and gradually work from the least anxiety-provoking trigger to the most. It may take 12 to 15 sessions of ERP to notice an improvement.10
What Happens If OCD Is Left Untreated?
OCD tends to be a progressive mental health condition, meaning that it gets worse without treatment. The condition may begin with small and subtle changes, but over time, the issues begin to interfere greatly with all aspects of a person’s life. Employment, housing, relationships, and physical health can all suffer when OCD is left untreated.
What If Someone Can’t Afford OCD Medication or Therapy?
If you are not able to afford medication or therapy, it is important to talk to your providers and see if they offer sliding scale options. If they are not able to offer those, you ask them if they can refer you to someone who does. In the meantime, you can go to a community clinic and learn about low cost options that may be available for you there or through a referral from the clinic.
Final Thoughts
If you’re struggling with OCD, you’re not alone. Speaking with a therapist and finding the right medication that works for you can help put you on the path to recovery. Don’t hesitate to reach out for help.
