Zoloft is a type of selective serotonin reuptake inhibitor (SSRI) that can help reduce symptoms of obsessive compulsive disorder (OCD), and target co-occurring conditions—like anxiety, depression, and post-traumatic stress disorder (PTSD). Luvox can be effective on its own, but is especially impactful when used in conjunction with exposure and response prevention therapy (ERP), which targets the behaviors at the root of the OCD cycle.
Exposure and response prevention therapy (ERP) and medications, like Zoloft (known by its generic name, sertraline) are the first-line treatments for a range of mental health conditions, including obsessive-compulsive disorder (OCD). While ERP and medication can be used separately to treat OCD, they can be most effective when used together.
Medication can reduce symptoms of OCD and commonly co-occurring conditions—like anxiety and depression—while ERP therapy can help you learn to respond differently to your intrusive thoughts and obsessions. Read on to learn more about how Zoloft works to reduce symptoms of OCD, and what you need to know about managing SSRI medication as a part of OCD treatment.
What is OCD?
OCD is characterized by a cycle of obsessions and compulsions that significantly impact a person’s daily life. Obsessions are intrusive thoughts, sensations, images, feelings, or urges that cause significant anxiety. Obsessions are usually ego-dystonic, meaning they directly contradict your core values and beliefs.
To try to reduce that distress, people with OCD engage in repeated mental or physical behaviors known as compulsions. Common compulsions include reassurance-seeking, avoiding situations that cause distress, checking, mental review, and excessive research. Whatever form your compulsions take, they only provide fleeting reliefand contribute to the OCD cycle.
What is Zoloft (sertraline)?
Zoloft belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs), along with Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), Luvox (fluvoxamine), and Paxil (paroxetine). While serotonin and norepinephrine reuptake inhibitors (SNRIs) and a tricyclic antidepressant (TCA) called clomipramine are also sometimes prescribed for OCD symptoms, SSRIs are the most common.
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 researchers are still working to understand exactly why SSRIs tend to reduce OCD symptoms. It’s likely that increased activity between nerve cells creates more gradual changes that lead to improvements in OCD symptoms.
SSRIs are also used to treat depression, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD)—conditions that frequently occur alongside OCD. In this way, medications like Zoloft can help you feel relief from other conditions that may be exacerbating your OCD symptoms or inhibiting your ability to seek treatment for OCD.
Side effects and risks
It’s important to educate yourself on the potential side effects of Zoloft. Many side effects are mild to moderate and tend to disappear within a few weeks, while others can persist for longer. Some of Zoloft’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, side effects may or may not impact you. You should discuss your individual needs and responses with your provider, and monitor your health carefully—especially during the first few weeks—to ensure that more serious side effects do not occur.
Treating OCD with Zoloft
Extensive studies have demonstrated that Zoloft and other SSRIs can be very effective at reducing OCD symptoms. In contrast to conditions like anxiety and depression, Zoloft is usually prescribed at a higher dose for OCD. According to Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD, a daily 200mg or higher dose of Zoloft is typical among OCD patients, whereas 75 mg or 100mg is typical for people with depression. He adds that doses of 300mg or even higher may be necessary to see an optimal reduction in symptoms in some OCD patients. Although outside the FDA-recommended range, years of clinical experience demonstrate that doses this high can be safe, tolerated, and effective for people with OCD.
“At higher doses, [Zoloft] practically becomes a different drug, working on an entirely different area of the brain,” he explains. He notes that higher doses do not necessarily mean more severe side-effects. As always, monitor your health after taking a new medication and remain in communication with your provider if any side effects emerge.
While SSRIs like Zoloft can be highly effective for OCD, these medications can take time to work. SSRIs typically reduce symptoms of anxiety and depression within two to four weeks, but it can take anywhere from six to 12 weeks to start reducing symptoms of OCD symptoms. Feusner says this is because “for OCD, on the time scale of six or eight weeks after treatment, there’s evidence that brain activity in the orbitofrontal cortex and caudate changes in response to medication, and that seems to relate to symptom improvement.” Lower doses of SSRIs used for anxiety and depression create changes in entirely different regions of the brain—a process which tends to happen in a shorter amount of time.
“In some cases, things continue to improve for [people with OCD] weeks or even months after that. Needless to say, this requires a lot of patience,” says Feusner. “There’s also a chance that Zoloft 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.” Feusner says at that point, a provider might recommend another type of SSRI, or another form of medication or treatment, entirely.
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Zoloft and ERP therapy
ERP therapy can be a helpful tool while you wait for the benefits of medication to kick in. It can also support in cases where SSRIs are not provoking a sufficient response. ERP therapy helps people with OCD rewire the way they respond to obsessions, and learn to resist compulsions altogether. While medications, like Zoloft, can treat the symptoms of OCD, ERP can create long lasting benefits that continue well beyond a course of treatment.
ERP therapy focuses on helping you confront your fears, anxieties, and triggers, while learning to resist engaging in compulsive behaviors. Through gradual exposures, a trained ERP therapist will help you learn to sit with discomfort, instead of immediately responding. ERP therapy can feel difficult, but it’s highly effective—and your therapist will work with you every step of the way to make sure you feel supported as you move through gradually more challenging exposures.
Often, medications like Zoloft can help make the process of ERP therapy feel easier—or even possible. If you’re struggling with depression, for example, it may feel hard to find the motivation or energy to embark on ERP exercises. In other cases, anxiety levels may simply feel too high to tolerate exposures. SSRIs, like Zoloft, can help target depression, anxiety, and the intensity of OCD symptoms, allowing you to engage more fully in treatment. In this way, medication and ERP therapy can be helpful complementary treatments for people navigating OCD.
It’s important to note that while you can treat OCD solely with Zoloft, OCD symptoms will likely return if and when you discontinue medication. That being said, if Zoloft’s side effects are not impacting you significantly, medication can be a long-term treatment option.
Bottom Line
Medications like Zoloft will not be necessary for every person navigating OCD, but they can make a big difference in reducing symptoms and targeting co-occurring conditions, like anxiety and depression. In many cases, SSRIs can give you the boost necessary to take on challenging therapeutic exercises, like ERP. Medications like Zoloft may take a while to kick in, and can have varying side-effects—so be sure to listen to your body, communicate with your provider, and practice patience. OCD recovery is not always immediate or linear, but pursuing treatment is worth it. In time, you can find relief from obsessions and compulsions, and regain control over your life.
Key takeaways
- Zoloft, a commonly prescribed SSRI, helps alleviate OCD symptoms by gradually reducing the intensity of obsessions and compulsions, but it may take some time to see results.
- ERP offers long-lasting benefits for OCD by breaking the cycle of obsessions and compulsions, while medications like Zoloft can complement therapy by making symptoms more manageable.
- Effective OCD treatment often combines ERP therapy and medication, depending on the individual person’s needs.