Medications for OCD: Effectiveness and Availability

If you have obsessive-compulsive disorder (OCD), you’re familiar with the cycle of obsessions and compulsions that can take over your day and keep you from living the life you want. Maybe you feel you spend an unreasonable amount of time on repetitive actions like scrubbing your hands or checking the locks, and you’re ready to find relief from your symptoms. 

While OCD is not a condition that gets better on its own, it is highly treatable thanks to an evidence-based therapy called exposure and response prevention (ERP). ERP works by helping people confront their obsessions and teaching them to resist engaging in compulsions in a safe and structured controlled environment. ERP is considered to be the gold standard for OCD treatment because it helps you develop long-term tools for resisting compulsions, which only make OCD symptoms worse over time. 

That said, medication is sometimes helpful as part of a broader treatment plan, particularly when combined with ERP therapy. This may be due to the severity of specific people’s symptoms, their individual psychology and neurobiology, or other conditions that impact them at the same time, such as major depressive disorder. For these people, a treatment plan developed by trained professionals combining therapy with medication can provide the best chance at long-term recovery.

Prescriptions for OCD: What medications can help?

For the most part, clinicians prescribe selective serotonin reuptake inhibitors (SSRIs) for OCD treatment. The immediate effect of SSRIs is to increase the amount of serotonin—a chemical that regulates mood and behavior—between nerve cells in certain parts of the brain. There is no conclusive evidence of a serotonin deficiency in people with OCD, though, so SSRIs most likely work through more gradual changes that occur as a result of higher serotonin levels. SSRIs are also frequently prescribed for anxiety and depression, so for people with OCD that have other mental health conditions, these medications might be especially helpful.

SSRIs, while considered to be the best existing option for OCD, don’t work for everyone. In these cases, other types of medication like tricyclic antidepressants (TCAs). Sometimes, clinicians prescribe atypical antipsychotics at low doses as an additive to SSRIs to increase their effectiveness. 

Categories of medications used for OCD

SSRIs, as noted above, work gradually by promoting increased activity in nerve cells responsible for serotonin production. They’re commonly prescribed for anxiety and depression, as well as OCD. “When you take SSRIs for anxiety or depression, it tends to work for most people within two to four weeks,” says Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD. “With OCD, it usually takes anywhere from about six weeks to about 12 weeks to start working. There’s also a chance that the drugs might not work sufficiently. At that point, a provider might prescribe another type of SSRI or something else entirely.”

Feusner also notes that SSRIs are prescribed at higher doses when being used to treat OCD, compared with the dosage for generalized anxiety disorder or depression. Here are some specific SSRIs that are commonly prescribed for OCD:

• Fluoxetine (Prozac) for adults and children 7 years and older
• Fluvoxamine (Luvox) for adults and children 8 years and older
• Paroxetine (Paxil) for adults only
• Sertraline (Zoloft) for adults and children 6 years and older
• Celexa (citalopram) for adults only
• Lexapro (escitalopram) for adults and children 12 years and older

TCAs are antidepressants that enhance communication between neurons in the brain. Clomopramine—the TCA most often prescribed for OCD—was created in 1964 to treat depression, but 20 years later researchers discovered that it was also effective for OCD. It works by slowing the rate of reabsorption of serotonin and norepinephrine in the brain, allowing the two chemicals to stay between nerve cells longer. Over several weeks, this can boost communication in these cells, which can improve mood, reduce symptoms of depression and anxiety, and minimize the intensity and frequency of obsessions and compulsions in people with OCD.

• Clomipramine (Anafranil) for adults and children 10 years and older

Atypical Antipsychotics work by modulating certain neurotransmitters in the brain, which can stabilize mood and reduce delusions and hallucinations if they are occuring. Originally approved for schizophrenia and bipolar disorder, the versatility of these drugs has led to its use in treating various mental health conditions, including major depressive disorder and, in some cases, OCD.

• Abilify (aripiprazole) for adults and children 6 years and older. Note the aripiprazole is still considered “off-label” for OCD in the US, as it does not have an FDA indication for OCD specifically.

Is there one best medication for OCD?

There is, unfortunately, no quick prescription fix for OCD, and everyone reacts to medications slightly differently. For that reason, there is no single best medication for OCD, though medication can be a crucial component of treatment for many people. If you’re interested in medication as a part of your OCD treatment journey, the most important thing is to work with a clinician who has specialized training and experience in OCD treatment.

When medications are used in OCD treatment (and when they’re not)

While many people achieve life-changing results with ERP alone, clinicians have consistently found that medications can be extremely beneficial—or even necessary—for people who have a hard time making progress in ERP. The medications help by reducing anxiety and distress to more manageable levels so that full participation in ERP exercises is easier.

Unlike ERP, medication alone is unlikely to lead to full recovery. But the majority of people find the greatest success when combining medication management with ERP therapy. In a randomized trial of patients who benefited from OCD medication, one group that didn’t experience sufficient benefits from medication alone added ERP, while the other group did stress management training for 17 weeks. Those who did ERP therapy experienced over three times the reduction in symptoms of the other group.

In the words of Kimberly Quinlan, LMFT, an OCD specialist, “medication alone is not a silver bullet for OCD recovery.”

According to an NOCD community member, a Prozac prescription helped address some of the anxiety related to her OCD. “In my experience so far the medicine doesn’t fully stop OCD but it helps to start the journey toward healing,” she wrote.

How to get a prescription for OCD medications

Although any licensed doctor can legally prescribe any of the drugs listed above, it’s most helpful to work with a board-certified psychiatrist who has training and experience treating OCD. That’s because OCD specialists will have a more in depth understanding of your symptoms and which medications could be most effective. The IODCF provider directory is a resource for finding OCD specialists by location, and the hundreds of trained OCD specialists in the NOCD Therapy directory regularly refer therapy members for medication management with trained providers. 

OCD Medication: What to consider before taking drugs to treat your condition

First of all, it’s important to remember that even if you decide to take medication for OCD, it doesn’t mean you have to take it forever. “Medication makes some people more able and willing to step in to do some of the scary tasks that we ask people to do in ERP,” says April Kilduff, LMHC, LCPC, LPCC, a therapist who specializes in treating OCD. Once patients get the hang of ERP and are able to manage their symptoms, many patients can work with their doctors to taper off the medication.

“We see whether the successes and gains they got in ERP are maintained or if they kind of start to dwindle as the med goes down.” explains Kilduff. While some people may need medication long-term, many people “realize they can get off the med and use what they learned with ERP to stay in recovery and to handle lapses when they come up.”

Also, it’s important to consider that medications have possible side effects, and that some OCD patients have a fear of taking pills, both of which may impact their ability to take their prescription. Speaking with a licensed professional who has specialized training in OCD is the best way to identify these side effects and triggers, and to determine what’s best for you. 

Does OCD medication have side effects?

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:

• Dry mouth 
• Constipation 
• Blurred vision
• Dizziness
• Drowsiness
• Weight gain
• Sexual dysfunction
• Nausea
• Insomnia

What other treatment exists for OCD?

For the few who don’t respond as well to ERP therapy or common OCD medications, ongoing research is promising for new medications that affect the neurotransmitter called glutamate. Since there’s evidence that glutamate dysregulation could be involved in some OCD symptoms, there are clinical trials for medications that regulate it to treat OCD—you may even be eligible to participate.

People who have reached a point in treatment where evidence-based, first-line treatments haven’t been effective might consult with an experienced clinician about medication options like glutamate modulators or other treatments like transcranial magnetic stimulation (TMS). Even for those who haven’t responded to several types of treatment, it’s still possible to find one, or a combination of several, that can help them conquer OCD.

Some clinicians also recommend self-guided techniques like journaling, mindfulness, or exercise to help relieve the anxiety that typically goes hand in hand with OCD—methods like these can help with the treatment journey.

Medication and mindfulness alone, however, can’t build lasting resilience against OCD obsessions and compulsions. Overall, ERP is the most effective treatment for OCD because it increases your ability to accept distress and uncertainty without relying on compulsions that only make your symptoms worse. You can learn to live a life free from OCD—even if the most common forms of treatment don’t work for you.