Recovery from Obsessive Compulsive Disorder (OCD) is a journey. With an average of 12.78 years often separating the onset of symptoms with an accurate diagnosis and a further 1.45 years, between that diagnosis from getting one of the two first-line treatments for the condition, it’s a journey that’s too often unacceptably delayed. Those distinct but often complementary approaches are exposure and response prevention therapy (ERP), and any one of a handful of medications proven to reduce OCD symptoms.
Specifically developed to treat OCD in the 1970s, ERP involves a specialty-trained therapist gradually exposing people with OCD to their fears or triggers, providing opportunities for them to resist engaging in their usual compulsive behaviors. This process helps people learn to tolerate the discomfort and distress caused by their obsessive fears. In most cases, ERP effectively reduces OCD symptoms over time, often within a matter of weeks.
The other first-line treatment for OCD is any one of a number of drugs that have shown efficacy in reducing the severity of OCD symptoms. One of the medications commonly prescribed for this purpose is citalopram, more commonly known by its brand name, Celexa.
Today, we’ll discover how Celexa works in treating OCD symptoms, while also introducing its limitations and potential side effects. We’ll also discuss the differences in treating OCD with ERP and Celexa, and look into how these approaches can often be used together to help people overcome OCD and get back to living life on their own terms.
What is Obsessive-Compulsive Disorder (OCD)?
OCD is a mental health condition characterized by a cycle of obsessions and compulsions that can profoundly impact the lives of sufferers and those around them. First described as a separate disorder in the nineteenth century, OCD affects people of all ages and backgrounds and is estimated to affect between 80 and 160 million people worldwide.
The causes of OCD are complex and not entirely understood. Researchers believe genetic, environmental, and neurological factors contribute to its development. They also posit that imbalances in brain chemistry may play a role in the manifestation of OCD symptoms.
In OCD, obsessions are intrusive and unwanted thoughts, images, or urges that cause intense distress. These obsessions are recurrent and difficult to control. Common obsessions revolve around harm, sexuality, relationships, contamination, among many others. People with OCD often recognize that these obsessions are irrational, yet struggle to dismiss or ignore them.
The other defining symptoms of OCD—compulsions—are the repetitive behaviors or mental acts that people with OCD engage in to alleviate the distress caused by their obsessions. Compulsions can be physical actions like excessive hand washing, arranging objects in a specific order, or mental rituals such as counting or praying. These rituals temporarily relieve anxiety, but the relief is short-lived, leading to a relentless cycle of obsessions, distress, compulsions, and temporary relief known as the “OCD cycle.”
The OCD cycle affects all aspects of a sufferer’s life. It can disrupt personal relationships, academic or work performance, and overall quality of life. People with OCD often spend significant time and energy engaging in their compulsions, which can be time-consuming and exhausting. Simple tasks like leaving the house, completing assignments, or making decisions are arduous and time-consuming due to the intrusive thoughts and rituals associated with OCD. This can lead to isolation, withdrawal from social activities, and difficulty maintaining fulfilling relationships. It can also lead to a higher risk of other mental disorders—such as major depression—and significantly increase the likelihood of the sufferer taking their own life.
What is Celexa (citalopram)?
Celexa (citalopram) is a medication that falls into a group of drugs called selective serotonin reuptake inhibitors (SSRIs) along with Lexapro (escitalopram), Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), and Paxil (paroxetine). Though serotonin and norepinephrine reuptake inhibitors (SNRIs) and a tricyclic antidepressant (TCA) called clomipramine are sometimes used to treat OCD symptoms, SSRIs are more frequently prescribed for this purpose.
The immediate effect of SSRIs is to increase the amount of serotonin between nerve cells in certain parts of the brain. However, there is no conclusive evidence of a serotonin deficiency in people with OCD, so the benefits of SSRIs in OCD treatment aren’t thought to be a result of this immediate effect. Rather, they most likely work as a tool to alleviate OCD symptoms through gradual changes that occur over time in response to these increased serotonin levels.
SSRIs are also used to treat depression, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD)—conditions that frequently co-occur with OCD—although the main mechanisms of action believed to alleviate symptoms of these disorders differ.
Celexa’s use in treating OCD
Celexa has been studied extensively and, like other SSRIs, has been shown to effectively reduce OCD symptoms. You’d be forgiven for wondering why people undergo potentially uncomfortable ERP sessions when an affordable, generic pill can effectively control OCD’s symptoms. One important consideration is the time required for Celexa and other medications to work.
“When you take Celexa 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, and, in some cases, things continue to improve for many weeks or even months after that. Needless to say, this requires a lot of patience. There’s also a chance that Celexa might not work sufficiently, or at all for an individual, but we really have to wait for at least 12 weeks to make that assessment. At that point, a provider might prescribe another type of SSRI or something else entirely.”
It’s worth noting that ERP usually results in a significant reduction of OCD symptoms within 12 to 20 weeks for most people. Another thing differentiating Celexa’s use in treating OCD as opposed to other mental disorders is the dose: “Usually, higher doses of Celexa are used for OCD compared to GAD or depression,” explains Dr. Feusner. “In fact, at higher doses, it practically becomes a different drug, working on an entirely different area of the brain.”
Exactly how much bigger are those doses? Feusner says that a daily 40mg dose of Celexa is typical among OCD patients, whereas 20 mg is a typical dose for people with depression. The FDA does not recommend doses higher than 40 mg for adults (20 mg for those 60 or older) as the risk of a heart rhythm abnormality increases beyond that dose.
Another thing people need to consider when taking Celexa is the side effects it’s associated with—side effects that people may experience whether the drug reduces their OCD symptoms or not. Many of these are mild to moderate and tend to disappear within a few weeks. That said, other side effects can persist longer. Some of Celexa’s more common side effects include:
- dry mouth
- insomnia
- reduced sex drive
- nausea
- dizziness
- fatigue
- diarrhea
- constipation
- decreased appetite
As is the case with all psychiatric medications, they should be considered carefully for each individual’s needs and monitored by their prescriber, particularly in the first few weeks, to ensure that more serious side effects do not occur. Dr. Feusner adds that if someone takes two or three times the dose of Celexa, that doesn’t mean that the side effects will be two or three times more severe.
The biggest difference medications have with the other first-line OCD treatment is that drugs treat the symptoms of the condition, while ERP can result in more long lasting benefits that continue beyond the episode of treatment. What that means is that if one discontinues their medication plan for OCD, it’s likely that their OCD symptoms will return as a result. If Celexa’s side effects are non-noticeable or easily managed, medication management can end up being a long-term option to keep OCD symptoms at bay, as it has been for many.
Often, however, medication like Celexa is used as a means of making ERP therapy more tolerable—or even possible—for some people, especially those with more severe and debilitating OCD symptoms. As a result, the two treatments can be complementary components of a person’s treatment journey.
These medications can help reduce anxiety and other distress associated with OCD, as well as the severity of obsessions and urges to do compulsions. Secondly, some (but not all) find it helpful to experience a moderate reduction in the severity of their obsessions, urges to do compulsions, and distress, in order to start difficult exposure exercises and resist engaging in compulsions, helping them gain response prevention skills throughout the ERP journey. Importantly, when someone is taking an SSRI like Celexa for OCD but there is not a sufficient response, research demonstrates that adding ERP is very effective in further reducing OCD symptoms.
In conclusion
While not always necessary for a full recovery, medications like Celexa can be an effective treatment option for people living with OCD. They’ve been shown to reduce obsessions, compulsions, and related anxiety, allowing people to regain control over their lives. And for some, the most effective treatment plans could involve a combination of ERP and medication to reduce symptoms.
NOCD therapists are specially trained in delivering ERP and regularly refer members to qualified prescribers who can identify medication that may reduce their OCD symptoms and/or the symptoms of other commonly co-occurring disorders such as depressive disorders and anxiety disorders. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment the NOCD Care Team to learn more about how a licensed therapist can help you or a loved one overcome OCD.