Medicines for OCD Treatment
When it comes to treating Obsessive-Compulsive Disorder (OCD), medication can be a powerful tool. While Exposure and Response Prevention therapy (ERP) is a highly effective treatment, medication can help reduce symptoms and make therapy and response prevention more manageable.
SSRIs: The First-Line Treatment
Selective Serotonin Reuptake Inhibitors (SSRIs) are the most widely recommended medications for OCD treatment. These medications help the brain transmit signals more effectively through the serotonin system which can help regulate mood and anxiety. The most commonly prescribed SSRIs for OCD include:
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Escitalopram (Lexapro) – FDA-approved for OCD in some European countries and sometimes prescribed off-label in the U.S.
Citalopram (Celexa) – Used off-label for OCD, though less commonly than other SSRIs.
While Escitalopram (Lexapro) and Citalopram (Celexa) may not have formal FDA approval for OCD treatment in the U.S., research and real-world use suggest they may still be beneficial for some individuals.
According to the International OCD Foundation (IOCDF), SSRIs often require higher doses for OCD treatment compared to depression or generalized anxiety disorder. (IOCDF)
Stanford Medicine also confirms that SSRIs remain the primary evidence-based pharmacological treatment for OCD, often showing the best response at high doses over an extended period. (Stanford Medicine)
SNRIs: An Alternative Approach
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) target both serotonin and norepinephrine, which can impact mood and anxiety regulation. While SSRIs are the preferred choice, Venlafaxine (Effexor XR) has shown efficacy in cases where SSRIs have been ineffective.
A study published by the National Institutes of Health (NIH) reviewed the effectiveness of venlafaxine in treatment-resistant OCD cases, noting that while not the first-line option, it may offer relief when SSRIs fail. (NIH)
Usual Dosages for these Medications
luvoxamine (Luvox®) - up to 300 mg/day
fluoxetine (Prozac®) - 40-80 mg/day
sertraline (Zoloft®) - up to 200 mg/day
paroxetine (Paxil®) - 40-60 mg/day
citalopram (Celexa®) - up to 40 mg/day*
clomipramine (Anafranil®) - up to 250 mg/day
escitalopram (Lexapro®) - up to 40 mg/day
venlafaxine (Effexor®) - up to 375 mg/day
*The FDA has issued warnings about using this medication at higher doses. Consult your physician for guidance.
Medications Not Typically Recommended for OCD
While SSRIs and some SNRIs are well-supported by research, certain medications are not considered first-line treatments for OCD.
Benzodiazepines (e.g., Xanax, Klonopin, Ativan) – These are sometimes used for short-term anxiety relief but do not effectively treat OCD (NIH). These can also interfere with memory and are not recommended for use while engaging in ERP.
Antipsychotics (e.g., Abilify, Risperdal) – Occasionally used as an add-on to SSRIs in treatment-resistant cases but not as a standalone OCD treatment. (UF Psychiatry)
Key Considerations About Medication for OCD
Dosage and Duration: Why People with OCD May Require Higher Doses
Research suggests that OCD treatment with medication is that people with OCD often require higher doses and longer treatment durations compared to individuals taking SSRIs for depression or anxiety. This is because OCD symptoms typically respond best to SSRIs when taken at the higher end of the dosing range. This may feel concerning to some, but it is a normal part of OCD treatment and should always be managed by a healthcare professional familiar with OCD.
The Anxiety & Depression Association of America (ADAA) further emphasizes that it may take 10–12 weeks at a therapeutic dose to see substantial symptom improvement. (ADAA)
Normalizing Dosage Increases & Extended Treatment Timelines
It’s understandable to feel concerned about increasing medication dosage or long-term treatment, but this is a well-documented and normal aspect of OCD pharmacology.
Medication & ERP Therapy: A Combined Approach
Medication alone is not a cure for OCD, but it can reduce symptoms enough to allow for more effective participation in Exposure and Response Prevention (ERP) therapy—an evidence-based, effective behavioral treatment for OCD. Studies suggest that combining medication with ERP therapy leads to better long-term outcomes. (Stanford Medicine)
Common OCD Obsessions About Medications
Many individuals with OCD have unique fears about taking medication, and these should be addressed with compassion, accurate education, and effective treatment.
1. Fear of Medication Warnings (e.g., Suicidal Ideation & Harm OCD)
Individuals with Harm OCD may fear that medication warning labels about suicidal ideation could exacerbate their intrusive thoughts. However, research shows that SSRIs are generally safe when monitored by a healthcare provider. (IOCDF)
2. Fear of Self-Harm or Poisoning
Those with OCD themes around self-harm or contamination may worry that taking medication could harm them through their being “irresponsible” or from the medication containing some sort of contaminant or poison. This is a common intrusive thought and working with a trusted doctor and ERP trained counselor can help ease these concerns.
3. Contamination OCD & Struggles with Medication
Individuals with Contamination OCD may struggle with handling medication due to fears of germs or toxins. This is also a common fear and can be managed successfully with ERP.
4. Fear of Vomiting (Emetophobia) & Medication Avoidance
Those with emetophobia (fear of vomiting), a common co-occurrence with OCD, may worry about nausea as a side effect. While some SSRIs may cause mild nausea initially, this often subsides with continued use. Consulting with a doctor can help manage these concerns. (ADAA)
Managing Side Effects of OCD Medications
Some people stop taking clomipramine or SSRIs because of side effects. According to Stanford Medicine, "Unpleasant side effects such as nausea, sexual dysfunction, sedation and weight gain can lead patients to discontinue clomipramine or SSRIs. Rare reports of akathisia, bleeding, easy bruising and suicidality exist." They also mention that some medications, like bupropion, buspirone, and sildenafil, may help with certain side effects. Nausea usually goes away over time and can be reduced by starting with a lower dose and increasing it slowly.
If you're struggling with side effects, talk to your doctor about ways to manage them while staying on track with your treatment.
The Importance of Accurate Education & Professional Guidance
Seeking medication treatment for OCD is a personal decision, and it’s crucial to work with a knowledgeable healthcare provider who understands OCD-specific concerns. The International OCD Foundation recommends working with an OCD specialist who is well-versed in both ERP therapy and medication management. (IOCDF)
My Personal Experience with SSRIs for OCD
I’ve personally taken SSRIs for OCD at different times in my life, and I’ve found them to be very helpful. While they are not a one-size-fits-all solution, they provided significant relief and helped me engage more effectively in response prevention to manage my OCD symptoms.
I also work with clients who take medication, and I’ve seen firsthand how much it varies from person to person. Some find it life-changing, while others prefer to manage their OCD without medication. The key takeaway? Everyone should have the right to choose and access evidence-based treatment options that align with their values and goals.
Take the Next Step in Your OCD Treatment
If you or someone you know is struggling with OCD and considering treatment options, I encourage you to explore both medication and ERP therapy as viable paths to recovery. Schedule a free 20-minute phone consultation today to learn how ERP therapy can help you manage OCD effectively.
