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Medications for OCD: Efficacy and Accessibility
If you have obsessive-compulsive disorder (OCD), you understand how the cycle of obsessions and compulsions can dominate your daily life, hindering you from achieving the life you desire. You might feel that you invest an excessive amount of time in repetitive behaviors, like washing your hands or checking locks, and are eager to find relief from these symptoms.
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Although OCD does not improve on its own, it is highly manageable through an evidence-based therapy known as exposure and response prevention (ERP). ERP assists individuals in facing their obsessions and teaches them to resist compulsions in a controlled and safe setting. Recognized as the gold standard for treating OCD, ERP equips you with long-term strategies to combat compulsions that ultimately exacerbate OCD symptoms over time.
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However, medication can also play a beneficial role in a comprehensive treatment strategy, especially when paired with ERP therapy. This is particularly true for those with more severe symptoms, unique psychological and neurobiological factors, or co-occurring conditions like major depressive disorder. For such individuals, a treatment plan created by trained professionals that combines therapy and medication offers the best opportunity for long-term recovery.
In This Article
Clinicians primarily prescribe selective serotonin reuptake inhibitors (SSRIs) for the treatment of OCD. SSRIs work by increasing the levels of serotonin—a neurotransmitter that influences mood and behavior—between nerve cells in specific areas of the brain. However, there is no definitive evidence indicating a serotonin deficiency in individuals with OCD, suggesting that SSRIs may be effective due to more gradual changes associated with elevated serotonin levels. Additionally, SSRIs are commonly used to treat anxiety and depression, making them particularly beneficial for individuals with OCD who also have other mental health conditions.
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While SSRIs are regarded as the best available treatment for OCD, they do not work for everyone. In such cases, clinicians may consider alternative medications, such as tricyclic antidepressants (TCAs). Sometimes, low doses of atypical antipsychotics are prescribed alongside SSRIs to enhance their effectiveness.​
SSRIs, as mentioned earlier, function gradually by enhancing the activity of nerve cells responsible for serotonin production. They are frequently prescribed for anxiety, depression, and OCD. According to Jamie Feusner, MD, a Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD, “When taking SSRIs for anxiety or depression, they typically begin to work for most individuals within two to four weeks. However, with OCD, it may take approximately six to twelve weeks to see results. There is also a possibility that the medication may not be effective enough, leading the provider to prescribe a different SSRI or an alternative medication altogether.”
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Feusner notes that SSRIs are often prescribed at higher doses for OCD compared to those used for generalized anxiety disorder or depression. The following SSRIs are commonly used for OCD treatment:
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Fluoxetine (Prozac) for adults and children aged 7 years and older
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Fluvoxamine (Luvox) for adults and children aged 8 years and older
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Paroxetine (Paxil) for adults only
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Sertraline (Zoloft) for adults and children aged 6 years and older
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Celexa (citalopram) for adults only
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Lexapro (escitalopram) for adults and children aged 12 years and older
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Tricyclic antidepressants (TCAs) enhance neuronal communication in the brain. Clomipramine, the TCA most frequently prescribed for OCD, was initially developed in 1964 for depression but was found to be effective for OCD two decades later. It works by slowing the reabsorption of serotonin and norepinephrine in the brain, allowing these neurotransmitters to remain between nerve cells longer. Over several weeks, this can improve communication between cells, alleviating symptoms of depression and anxiety while reducing the intensity and frequency of OCD obsessions and compulsions.
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Clomipramine (Anafranil) for adults and children aged 10 years and older
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A typical antipsychotics modulate certain neurotransmitters in the brain, which can help stabilize mood and reduce delusions and hallucinations when present. Initially approved for conditions like schizophrenia and bipolar disorder, these medications are also used to treat various mental health issues, including major depressive disorder and, in some instances, OCD.
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Abilify (aripiprazole) for adults and children aged 6 years and older. It is important to note that aripiprazole is considered “off-label” for OCD in the U.S., as it does not have a specific FDA indication for this condition.
Is there one best medication for OCD?
Unfortunately, there isn't a quick prescription solution for OCD, and individuals respond to medications in varying ways. As a result, there isn't a one-size-fits-all medication for OCD; however, medication can be a vital part of treatment for many. If you're considering medication as part of your OCD treatment, it's essential to collaborate with a clinician who has specialized training and experience in treating OCD.
While many individuals achieve transformative results with ERP alone, clinicians consistently observe that medications can be extremely helpful—or even essential—for those struggling to make progress in ERP. These medications aid in lowering anxiety and distress to more manageable levels, facilitating greater participation in ERP exercises.
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In contrast to ERP, relying solely on medication is unlikely to lead to complete recovery. Most individuals find the best outcomes when combining medication management with ERP therapy. A randomized trial involving OCD patients revealed that one group, which added ERP after not achieving sufficient benefits from medication alone, experienced over three times the reduction in symptoms compared to a group that underwent stress management training for 17 weeks.
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As Kimberly Quinlan, LMFT, an OCD specialist, states, “medication alone is not a silver bullet for OCD recovery.”
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A community member from NOCD shared that a Prozac prescription helped alleviate some of the anxiety associated with her OCD. She noted, “In my experience so far, the medicine doesn’t fully stop OCD, but it helps to start the journey toward healing.”
While any licensed physician can legally prescribe the medications mentioned above, collaborating with a board-certified psychiatrist who specializes in treating OCD is most beneficial. These specialists possess a deeper understanding of OCD symptoms and can recommend the most effective medications. The IODCF provider directory serves as a resource for locating OCD specialists in your area, and the numerous trained OCD specialists in the NOCD Therapy directory frequently refer therapy members to qualified providers for medication management.
It's essential to understand that choosing to take medication for OCD doesn't imply a lifelong commitment. As April Kilduff, LMHC, LCPC, LPCC, a therapist specializing in OCD treatment, explains, medication can help individuals feel more capable and motivated to engage in the challenging tasks involved in ERP. Once patients become comfortable with ERP and start making progress, they may find they no longer need medication to support their treatment.
Each medication comes with potential side effects. Just because a side effect is listed on the bottle, doesn’t necessarily mean it will impact you—many people experience no adverse effects, or very few, from psychiatric medication whatsoever, and side effects may greatly diminish over time. That’s why it’s crucial to take medication of any kind under the guidance of a trained, licensed professional. Some common side effects across SSRIs, TCAs and atypical antipsychotics include:
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Dry mouth
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Constipation
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Blurred vision
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Dizziness
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Drowsiness
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Weight gain
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Sexual dysfunction
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Nausea
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Insomnia
For those who do not respond effectively to ERP therapy or standard OCD medications, ongoing research offers hope through new medications that target the neurotransmitter glutamate. Since there is evidence suggesting that glutamate dysregulation may contribute to some OCD symptoms, clinical trials are currently underway for medications designed to regulate this neurotransmitter, and you might even qualify to participate.
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Individuals who find that first-line, evidence-based treatments have not worked may seek guidance from experienced clinicians regarding alternative medication options, such as glutamate modulators, or consider other therapies like transcranial magnetic stimulation (TMS). Even those who have not responded to multiple treatment methods can still discover a suitable option, or a combination of treatments, that effectively addresses their OCD.
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Additionally, some clinicians suggest self-directed strategies such as journaling, mindfulness practices, or exercise to alleviate the anxiety often associated with OCD. While these methods can aid in the treatment process, they are not sufficient on their own to build lasting resilience against OCD's obsessions and compulsions. Ultimately, ERP remains the most effective approach for OCD, as it helps individuals accept distress and uncertainty without resorting to compulsions, which typically exacerbate symptoms. With the right treatment, you can learn to live a life free from the constraints of OCD, even if the most common treatments initially fall short.