Obsessive-Compulsive Disorder (OCD) affects millions of people in the U.S. alone. While there are many treatment options available, medication for OCD has been proven to reduce obsessive thoughts and compulsive behaviors. Knowing how these medications work and what to expect can help you feel more confident about your treatment plan.
Can Antidepressants Help OCD Symptoms?
Yes, antidepressants are a common treatment option for OCD. These medications target chemical imbalances in the brain, which helps provide relief from symptoms.
Types of Medications Prescribed for OCD
Several types of medications are used to treat OCD. The first line of treatment is usually Selective Serotonin Reuptake Inhibitors (SSRIs), but other options, like tricyclic antidepressants and off-label medications, may be considered for patients with treatment-resistant OCD.
Selective Serotonin Reuptake Inhibitors
SSRIs are the most commonly prescribed medications for OCD. They work by increasing serotonin levels in the brain, which is a neurotransmitter responsible for mood and emotional regulation. Per the American Psychiatric Association, common SSRIs and their dosages include:
| Medication | Minimum Dosage | Maximum Dosage |
| Sertraline | 50 mg | 200 mg |
| Paroxetine | 20 mg | 60 mg |
| Citalopram | 20 mg | 80 mg |
| Clomipramine | 25 mg | 250 mg |
| Escitalopram | 10 mg | 40 mg |
| Fluoxetine | 20 mg | 80 mg |
| Fluvoxamine | 50 mg | 300 mg |
Research suggests that SSRIs are most effective when doses reach 40 mg fluoxetine equivalent. However, increasing doses beyond this point can result in decreased efficacy and may cause more side effects.
Tricyclic Antidepressants
Tricyclic antidepressants are a second-line of treatment for OCD. Although they work similarly to SSRIs by inhibiting serotonin reuptake, they also block other receptors like norepinephrine and histamine. This can lead to more adverse side effects.
Clomipramine is a common tricyclic antidepressant that is used for OCD. However, it is generally reserved for patients who do not respond well to SSRIs due to its less favorable side effects. Despite this, it has shown similar efficacy to SSRIs in reducing OCD symptoms.
Off-Label Medications for OCD
For patients who do not fully respond to SSRIs or clomipramine, off-label medications like antipsychotics may be added as supplemental therapies. While not FDA-approved for OCD, certain antipsychotics have shown benefits for treatment-resistant cases. Commonly recommended antipsychotics and their dosages include:
| Medication | Starting Dose | Suggested Dose |
| Aripiprazole | 2-5 mg | 15-30 mg |
| Haloperidol | 1-2 mg | 2-4 mg |
| Olanzapine | 2.5-5 mg | 5-10 mg |
| Quetiapine | 50-150 mg | 150-600 mg |
| Risperidone | 0.25-1 mg | 1-2 mg |
One-third of patients with treatment-resistant OCD show a positive response to adjunctive antipsychotic therapy. These medications are often prescribed in low doses to minimize potential side effects.
Side Effects of OCD Medications
While medications for OCD can be effective, they may come with side effects, especially during the first weeks of treatment. SSRIs are often well tolerated, but common side effects may include:
- Nausea
- Nervousness or restlessness
- Trouble sleeping
- Decreased libido
These side effects typically go away after the first few weeks of consistent use as the body adjusts to the medication.
Clomipramine can cause a wider range of side effects due to its influence on multiple neurotransmitter systems. Common side effects include:
- Nausea, increased appetite, and weight gain
- Sedation and fatigue
- Dry mouth, constipation, and urinary retention
- Blurred vision and dizziness
- Sweating and anxiety
Rare but serious side effects may include heart issues such as arrhythmia and QTc prolongation, seizures or hyperthermia, and increased risk of suicidal thoughts.
Lastly, while antipsychotics can be effective in treatment-resistant cases, they may worsen OCD symptoms in some cases.
How to Manage Side Effects
Most mild side effects improve as the body adjusts to the medication. However, there are steps you can take to manage any discomfort you might experience:
- Take medication with food if you experience nausea.
- Take doses in the morning if you have trouble sleeping, but only with doctor approval.
- Drink plenty of water or other fluids if diarrhea is an issue.
- Eat more high-fiber foods for constipation side effects.
It’s important that you stay in communication with your doctor. They can adjust your dosage or help you explore other treatments if necessary.
What to Consider Before Taking Medicine for OCD
Before taking medicine for your OCD, it may be a good idea to weigh the potential benefits and risks. Here are some tips to make sure medication is the right treatment for you:
- Consider possible side effects as some medications can cause temporary distress.
- Review your medical history with your healthcare provider to identify any conditions that may affect your treatment.
- Discuss potential drug interactions if you are already taking other medications.
By following the above steps, you and your doctor can come up with the best treatment plan for you and your needs.
Medication Alone vs. Combined Treatment
For many patients, a combination of therapy and medication is the most effective treatment for OCD. Clinical research supports the benefits of integrated care:
- Cognitive Behavioral Therapy (CBT) combined with SSRIs is recommended for those with severe or treatment-resistant OCD. Research has shown this leads to more improvements compared to medication or therapy alone.
- APA guidelines suggest that combined treatment can be beneficial for those managing OCD alongside co-occurring conditions like anxiety or depression.
- Studies indicate that the effects of combined treatments, like CBT and SSRIs, consistently fall within moderate to high ranges.
Other treatments besides CBT can also be used alongside medication to see better results. Exposure and Response Prevention (ERP), for example, exposes patients to their triggers in a safe environment so they can develop coping skills to keep their compulsive behaviors from taking over.
For treatment-resistant cases, transcranial magnetic stimulation (TMS) for OCD may be beneficial as well. It’s non-invasive and often has fewer side effects than medications, so patients can go about their day with minimal interruption.
While medication has been shown to minimize the symptoms of OCD, it won’t make symptoms completely disappear. This is why many healthcare providers recommend additional treatments that provide real-life coping strategies to help patients address and manage their triggers.
Finding Medication for OCD in Los Angeles
While almost any doctor can prescribe medication for OCD, working with a Los Angeles board-certified psychiatrist who specializes in mental health is often the best choice. Psychiatrists with experience treating OCD will have in-depth knowledge of the condition, and they’ll be up to date on the latest research so they can provide their patients with the best possible care. If you’re looking for medication for OCD in L.A., reach out to a trusted local mental health provider to find the right medication and support you need.
Sources:
- Who Gets OCD? – International OCD Foundation
- Obsessive-compulsive disorder (OCD): Learn More – Treatments for obsessive-compulsive disorder – InformedHealth.org
- Optimal Dose of Serotonin Reuptake Inhibitors for Obsessive-Compulsive Disorder in Adults: A Systematic Review and Dose–Response Meta-Analysis – Frontiers in Psychiatry
- Drug Therapy for Obsessive-Compulsive Disorder – U.S. Pharmacist
- Moving beyond first-line treatment options for OCD – Mental Health Clinician
- Clomipramine – StatPearls
- Antipsychotic-Induced Obsessive-Compulsive Disorder – Rho Chi Post
- The effectiveness of exposure and response prevention combined with pharmacotherapy for obsessive-compulsive disorder: A systematic review and meta-analysis – Frontiers in Psychiatry
- Optimizing first line treatments for adults with OCD – Comprehensive Psychiatry
