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 paroxetine, more commonly known by its brand name, Paxil. Other brand names for paroxetine include Brisdelle, Paxil CR (controlled release), Pexeva, Seroxat, Paxera, Apotex, and others.
Today, we’ll discover how paroxetine 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 paroxetine, 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. 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 or to prevent unwanted outcomes. These can include 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, and obsessions tend to recur and get worse over time, contributing to a vicious cycle of OCD symptoms.
When OCD is left untreated, the impact of distressing obsessions and disruptive, time-consuming compulsions can impact all areas of life. Simple tasks like leaving the house, completing assignments, or making decisions may become difficult, leading to isolation, withdrawal from social activities, and difficulty maintaining fulfilling relationships.
What is Paxil (paroxetine)?
Paxil (paroxetine) 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 Celexa (citalopram).
The immediate effect of SSRIs is to increase the amount of serotonin between nerve cells in certain parts of the brain. However, as OCD is not believed to cause or result from a serotonin deficiency, the direct effect of SSRIs is not believed to be the reason for their effectiveness in treating OCD. Rather, they most likely work as a tool to alleviate OCD symptoms through gradual changes that occur in response to increased activity in these nerve cells.
Paxil ’s use in treating OCD
Paroxetine has been studied extensively and, like other SSRIs, has been shown to effectively reduce OCD symptoms. While these medications, like ERP therapy, are considered first-line treatment options for the condition, these approaches differ in two crucial ways. One important consideration is the time required for paroxetine and other medications to work.
“When you take paroxetine for conditions like anxiety or depression, you’re likely to see results within two to four weeks for most people,” says Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD. “When used for OCD, it usually takes anywhere from about six weeks to about 12 weeks for an SSRI like paroxetine to start working, and things can continue, in some cases, 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 paroxetine 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.”
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 paroxetine’s use in treating OCD as opposed to other mental disorders is the dose: “Usually, higher doses of paroxetine 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.” Feusner notes that daily 40mg or higher doses of paroxetine is typical among OCD patients, whereas 20 mg is a typical dose for people with depression.
Another thing people need to consider when taking paroxetine is the side effects it’s associated with—side effects that people may experience whether or not they respond to the medication. Many of these are mild to moderate and tend to disappear within a few weeks, but others may persist longer. Some of the more common side effects associated with paroxetine include:
- dry mouth
- insomnia
- reduced sex drive
- nausea
- dizziness
- fatigue
- diarrhea
- constipation
- decreased appetite
- Withdrawal symptoms if stopped abruptly
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 emphasizes that if someone takes two or three times the dose of paroxetine, that doesn’t necessarily mean that the side effects will be two or three times more severe.
The second and biggest difference medications have with ERP therapy is that they effectively treat the symptoms of the condition, while ERP for many can result in more long lasting benefits that continue beyond the episode of treatment. In other words, if someone’s treatment plan for OCD consists of medication management alone, their symptoms are likely to return again if they discontinue treatment. That said, if paroxetine’s side effects are non-noticeable or easily managed, it can end up being a long-term option to keep OCD symptoms at bay—and has been for many.
It’s important to note, however, that medications like paroxetine are often used in conjunction with ERP, making therapy more tolerable—or even possible—for some people, especially those with the most severe OCD symptoms. Secondly, some (but not all) find it helpful to experience a moderate reduction in the severity of their symptoms in order to engage fully in difficult exposure exercises in ERP and learn to resist engaging in compulsions. Importantly, when someone is taking an SSRI like paroxetine for OCD but there is not a sufficient response, research demonstrates that adding ERP is very effective in further reducing OCD symptoms.
Where you can get help
While not always necessary for everyone for a full recovery, medications like paroxetine can be an effective treatment option for people living with OCD. And for many, the most effective treatment may involve a combination of ERP therapy to build long-term management strategies for OCD, and medication management 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. If you think that you may be struggling with OCD, I encourage you to read more about NOCD’s evidence-based approach to treating OCD.