Medication for OCD: Pros, Cons, & FAQs

Part of our OCD articles. For evaluation and medication management, see OCD care at Ridge Way.

Obsessive-compulsive disorder (OCD) can take up hours of a day. The most effective treatments are a type of therapy called exposure and response prevention (ERP) and a class of medications called serotonin reuptake inhibitors. Many people use one, the other or both.

This article explains which medications are used for OCD, how long they take to work, their benefits and drawbacks, and common questions about taking them.

How Medication Helps Manage OCD

The medications prescribed most often for OCD are antidepressants that target serotonin, a chemical messenger in the brain. They can reduce how strong and frequent obsessions and compulsions feel.

Medication does not cure OCD. Most people with OCD find that medication, often combined with psychotherapy, helps them manage their symptoms. It is often used alongside ERP, which a trained therapist provides.

Commonly Prescribed Medications for OCD

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the first-line medications for OCD. Most of the medicines that help with OCD are also known as antidepressants. Examples include the following.

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Escitalopram (Lexapro)

Of these, fluoxetine, sertraline, fluvoxamine and paroxetine have FDA approval for OCD. Our page on how antidepressant medication is used explains more about this group of medicines.

OCD often needs higher doses. On average, SSRI doses up to two to three times higher than those typically used for depression and anxiety give the greatest benefit for OCD. Your prescriber raises the dose step by step and watches for side effects.

A fair trial takes 8 to 12 weeks. Response to SSRIs takes longer in OCD than in depression or anxiety disorders. An adequate trial lasts 8 to 12 weeks, with at least six of those weeks at a moderate to high dose.

2. Clomipramine (Anafranil)

Clomipramine is a tricyclic antidepressant with FDA approval for OCD. It is commonly tried when a person has not improved enough after one or two SSRIs. Its most common side effects are dry mouth, trouble starting urination, constipation, weight gain and sexual side effects.

3. Other Medications

When SSRIs or clomipramine are not effective enough, other options may be considered.

• Venlafaxine (Effexor XR). A serotonin-norepinephrine reuptake inhibitor (SNRI) that the International OCD Foundation lists among medicines that can work for OCD.
• Antipsychotic augmentation. About one third of people who do not respond well enough to an SSRI alone improve when a low dose of aripiprazole or risperidone is added.

Pros of Medication for OCD

Symptom Reduction

About 40 to 60 percent of people with OCD have a clinically significant improvement on an SSRI. The average improvement is a 40 to 50 percent drop in symptom severity.

Improved Quality of Life

When obsessions and compulsions take up less time, there is more room for school, work, family and the things a person values.

Adjunct to Therapy

Medication can be used by itself or together with ERP. For some people, ERP can lower the risk of relapse that can follow stopping an SSRI. A licensed prescriber, such as a psychiatrist or psychiatric nurse practitioner, manages the medication. Ideally, the prescriber works with the person’s therapist on one treatment plan.

Cons of Medication for OCD

Side Effects

SSRIs can cause side effects. Common ones on the sertraline label include nausea, loose stools, tremor, indigestion, decreased appetite, sweating and sexual side effects. Clomipramine has its own set of side effects, listed above.

Antidepressants carry an FDA boxed warning. In short-term studies they increased the risk of suicidal thoughts and behavior in children, teens and young adults, so close monitoring matters, especially early on and after dose changes. If you notice new or worsening thoughts of suicide or self-harm, call or text 988, or call 911 if there is immediate danger.

Delayed Onset

OCD medication takes time. It can take 8 to 12 weeks before symptoms begin to improve, and some people keep improving for months after that.

Not a Cure

Medication helps while you take it, but it does not appear to keep working years after it is stopped. The relapse rate after stopping an SSRI is high, so long-term treatment is commonly recommended.

Stopping Medication Takes a Plan

Stopping an SSRI suddenly can cause discontinuation symptoms. The sertraline label lists symptoms such as nausea, sweating, irritability, dizziness, electric shock sensations, headache, anxiety and trouble sleeping.

The label recommends a gradual dose reduction rather than stopping abruptly whenever possible. Do not stop or lower your medication without first talking to your prescriber. Your prescriber can plan a taper and watch for a return of OCD symptoms.

The Role of a Healthcare Team

Medication for OCD works best when you and your prescriber stay in close contact. Your prescriber adjusts the dose, checks on side effects and decides with you when a trial has been long enough.

Ridge Way provides OCD care, including psychiatric evaluation and medication management, for adults, teens and children age six and older. We do not provide psychotherapy. When ERP is part of your plan, our medical team can refer you to an OCD-trained therapist.

When to Get Help

Consider an evaluation if obsessions or compulsions take up more than an hour a day, cause significant distress or get in the way of work, school or relationships. It also makes sense to ask if a current medication has not helped after a full trial, or side effects are hard to manage.

Ridge Way sees patients across Georgia through telehealth and at our Sugar Hill office. You do not need a referral unless your insurance plan requires one. Request an appointment and we will usually call you back within one business day.