As therapists here at Anxiety Specialists of St. Louis, we provide behavioral treatments for OCD. However, many people also have questions about medication and other interventions for OCD. In this post I’ll provide some general information about medication for OCD, as well as some other less common treatment options, and answer some questions we’re often asked. Please understand that this is not medical advice and should be considered an overview of information, not specific suggestions. Always consult with your doctor about what treatment options are best for you.
How is OCD treated?
Most commonly, OCD is treated with both therapy and medication. Therapy for OCD includes Exposure and Response Prevention (ERP) or Inference Based Therapy for OCD. You can read about ERP here.Therapy can be delivered in several ways, including individually or in a group format. At times, a more intense dose of therapy is needed, which could include meeting individually with a therapist several times per week or completing an intensive outpatient program (several hours per day, five days a week) or residential treatment (going to stay at a treatment center to receive full-time therapy, typically for one month or more).
OCD can also be treated with medication. The following information about medication is intended to be general medical information and should not be considered medical advice. Please speak to your provider about your specific concerns and health profile. In addition, this information is about medication for adults. Medication for children or teens with OCD may differ.
There are several potential benefits to taking medication for OCD. This first benefit is that the frequency of your intrusive thoughts and the intensity of your anxiety and distress may decrease. For some people, this decrease is significant on its own. In this way, medication “takes the edge off,” which can allow people to practice using the skills they gain in therapy more effectively. This, in turn, can result in even more improvement, which is an additional benefit of medication.
What medications are used to treat OCD?
The most commonly prescribed medications for OCD are SSRIs.
SSRIs are a class of medications that block the reuptake of serotonin, a neurotransmitter associated with mood, anxiety, and impulse control. Blocking the reuptake of serotonin leaves more serotonin is in the brain.
You can visualize this by imagining boats cruising around in a harbor. The harbor is your brain and each boat is a serotonin molecule. When you take an SSRI, it blocks off some of the docks where the boats would normally land. Since the docks are blocked and the boats can’t land, more boats will be floating in the harbor than usual. SSRIs work a little like that.
SSRIs are often considered first-line treatments for depression as well. However, not all antidepressants are effective for treating OCD.
Several antidepressants have been approved by the FDA for treating OCD.
These include:
Clomipramine (Anafranil)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
If you don’t respond to the first SSRI, it is generally recommended to try a second SSRI and then a 3rd before moving on to a different medication class.
If your SSRI only helps a little, your prescriber might also consider adding an atypical antipsychotic. While this might sound scary, this is a common approach to boosting effects for SSRIs and can improve insight into your thinking patterns.
What are the dosages for medication for OCD?
In terms of dosage, the general guidelines usually have a fairly wide range and depend on the medication. The exact dosage will depend on how you respond to the medication and other factors related to your health profile. Typically, your doctor will start with the lowest recommended dose and gradually increase over time until you find the right dose for you.
The recommended dosage for OCD is typically higher than that for depression.
Clomipramine: 100–250 mg/day, up to 300mg for OCD
Fluoxetine: 20–80 mg/day, up to 120mg for OCD
Fluvoxamine: 100–300 mg/day, up to 400mg for OCD
Paroxetine: 40–60 mg/day, up to 100mg for OCD
Sertraline: 50–200 mg/day, up to 400mg for OCD
If you are taking one of these SSRIs and feel like you haven’t fully benefitted, consider talking with your prescriber about increasing the dosage.
How do I know which medication is right for me?
It’s important to collaborate with your doctor to find the best option. Your doctor will ask about your specific past experiences with medication and your general preferences. They might also ask about your symptom history and the severity of your symptoms. Many doctors start with a low dose and then monitor any side effects, your symptom response, and other factors. Based on this information, they will make any adjustments to the dose that are needed. This can take several weeks or months, so try to be patient.
Your prescriber will also give you some general information about medications for OCD, including the risks and benefits, side effects, interactions with other medications, and the possibility of relapse.
It’s also important to take your medication every day as prescribed. It can be hard to do this at first, but there are several strategies you can use to increase the chances that you’ll be able to adhere to your plan. It’s also important not to stop taking your medication if you start to feel better. Be sure you check in with your prescriber before making any adjustments to how much or how often you’re taking your medication.
How long does SSRI medication take to work?
In general, SSRIs take between 8 and 12 weeks to take full effect. It’s important to let enough time pass for the medication to work before making any decisions about changes.
What if I’m afraid to take the medication?
This is common. It’s likely that your OCD is also fueling worries about taking medication. You aren’t alone in this. If you’re doing ERP therapy, your therapist can help you gradually take steps to work toward taking the medication. Talk with them openly about your fears, and they can help.
What are the risks of medication for OCD?
Overall, SSRIS are generally safe and effective. The most common risk associated with medication for OCD is side effects. For most people, side effects are mild and go away on their own within a few weeks. Common side effects of SSRIs include nausea, diarrhea, insomnia, drowsiness, headache, dry mouth, dizziness, restlessness, and sexual problems.
However, more serious side effects are also possible, including serotonin syndrome, bleeding, movement problems, hallucinations, and mania. If you experience these symptoms, reach out to your prescribing doctor right away.
Can genetic testing help me to choose the right medication for OCD?
Overall, the research examining the effect of genetic testing on improving treatment response for medication is mixed. While some studies have shown that selecting a medication based on a patient’s genetic profile improves outcomes, other studies have not found a benefit to genetic testing. Given the inconsistency in findings, we do not recommend testing at this time, especially as it can be costly. However, if you are considering genetic testing for psychiatric medication, it is important to talk to your doctor about the risks and benefits. Your doctor can help you to decide if genetic testing is right for you.
What about TMS for OCD treatment?
TMS stands for Transcranial Magnetic Stimulation. TMS involves creating a magnetic field and then directing that field toward certain nerve cells in the brain. This type of brain stimulation can change the way the brain works. TMS is noninvasive and is often administered in a doctor’s office or clinic. It’s not painful, but can be uncomfortable at times. Sessions usually last around thirty minutes, and the treatment packages usually include twenty to thirty sessions over the course of several weeks.
There is some evidence that brain stimulation can be effective for OCD. One study found that TMS was more effective than a placebo stimulation condition and another study found that TMS was effective for OCD, but only for 35% of patients. Overall, this area of research is still growing, and most studies have small sample sizes and low response rates. More research on TMS for OCD is needed before we can make more confident recommendations about who might be a good fit for TMS.
If you have specific questions and are looking for medical advice, please reach out to a psychiatrist. You can connect with one through the International OCD Foundation or through the American Psychiatric Association.