Research has shown that Lexapro can be effective in reducing OCD-related obsessions, compulsions, and anxiety. That said, it’s important to keep in mind that the medication takes time to work and may come with potential side effects.
When it comes to treating obsessive-compulsive disorder (OCD), exposure and response prevention (ERP) therapy and medication are widely considered the most effective options. ERP is a specialized form of cognitive behavioral therapy (CBT) that was created to treat OCD, and it’s been shown to be effective for up to 80% of the people who use it. While ERP therapy focuses on breaking the cycle of obsessions and compulsions through behavioral techniques, medication can help reduce the severity of symptoms, making them easier to manage.
Among the medications commonly prescribed for OCD is escitalopram, better known by its brand names Lexapro or Cipralex. In this article, we’ll explain how Lexapro works, when it might be recommended as part of OCD treatment, dosage and side effects, and what to consider before starting it.
How Lexapro is used to treat OCD
Lexapro belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs), the most commonly used type of antidepressant. SSRIs are traditionally prescribed to treat a variety of mental health conditions, including depression, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD).
SSRIs work by changing how signals are transmitted in certain parts of the brain. Changing brain transmission as a result of SSRI treatment has been shown to improve symptoms of depression and anxiety, helping people become more responsive to therapy and positive lifestyle changes like regular exercise.
There’s no solid evidence OCD is caused by serotonin deficiency. Instead, the benefits of SSRIs in treating OCD are believed to come from gradual changes that happen over time (changing brain transmission in certain areas) as the brain adjusts to the immediate effects of increased serotonin in-between nerve cells.
It’s estimated that anywhere between 40 and 60% of people with OCD may experience a positive response to SSRI treatment, including Lexapro.
While Lexapro does not specifically have an FDA indication for treating OCD, research and clinical experience show that it is effective at reducing symptoms. Lexapro can help alleviate obsessions, compulsions, and related anxiety—and, in many cases, it allows people to experience greater results from ERP therapy.
Lexapro dosage for OCD
When treating OCD, higher doses of Lexapro are used when compared to GAD or depression, says Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD.
According to Dr. Feusner, a daily 40mg dose of Lexapro is typical among OCD patients, whereas 20 mg is a typical dose for people with depression. He adds that doses of 50 or even 60 mg may be necessary to see an optimal reduction in symptoms in some OCD patients. Although outside the FDA-recommended range, there is evidence that off-label usage of SSRIs can be safe, tolerated, and effective for some people.
“What I tell patients is that when you have a higher dose of [an SSRI], it’s almost like having a different medication, because it’s affecting a different part of the brain and it takes a different amount of time to do so,” explains Dr. Feusner.
How long does it take for Lexapro to start working?
“When you take Lexapro for anxiety or depression, it tends to work for most people within two to four weeks,” says Dr. Feusner. “With OCD, while some may start to respond sooner, it can take anywhere from about six weeks to about 12 weeks to start working, and in many cases, things continue to improve for many weeks or even months after that. Needless to say, this requires a lot of patience.”
So why does it take longer for Lexapro to work for OCD than it does for depression or anxiety? “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,” he says. 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.
When treating OCD, Dr. Feusner notes, Lexapro may or may not work sufficiently—or at all—depending on the individual. In order to make that assessment, you’ll need to wait at least 12 weeks. At that point, your healthcare provider might prescribe another type of SSRI, or another form of medication entirely.
Side effects
When considering Lexapro, it’s important to be aware of potential side effects. While many of them are mild to moderate and tend to dissipate within a few weeks, some can persist for longer.
Common side effects of Lexapro include:
- Dry mouth
- Insomnia
- Reduced sex drive
- Nausea
- Dizziness
- Fatigue
- Diarrhea
- Constipation
- Decreased appetite
- Weight gain
Dr. Feusner notes that just because a person with OCD is taking two or three times the dose of someone using Lexapro for depression or anxiety, the side effects aren’t typically two or three times more severe.
Taking Lexapro (as well as any other psychiatric medication) should always be carefully monitored by your prescriber, especially during the first few weeks. Let your psychiatrist know if you are experiencing any side effects or sudden changes in your mood.
Is Lexapro right for me?
Psychiatric medication recommendations will depend on your age, health history, what other medications you take, and factors such as pregnancy and breast/chestfeeding. People with liver or kidney issues may require dose adjustments or careful monitoring when taking Lexapro. The best way to find out if medication makes sense for your OCD treatment is by speaking with your healthcare provider.
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Combining Lexapro with ERP therapy
Lexapro can be prescribed to treat OCD on its own or in combination with exposure and response prevention therapy (ERP), a specialized form of cognitive behavioral therapy (CBT) that was created specifically for people with OCD.
Using medication alone helps manage symptoms, but stopping the medication may cause OCD symptoms to return. If Lexapro effectively reduces symptoms without causing intolerable side effects, it may be a suitable long-term option for some people.
ERP is a behavioral therapy that works by breaking the cycle of obsessions and compulsions, making symptoms less intense and easier to manage independently. While ERP has been proven to be effective on its own, it’s common to pair therapy with medication, especially for those with more severe OCD. Research shows that combining ERP with an SSRI, such as Lexapro, can further reduce symptoms.
Lexapro can help ease anxiety and lower the intensity of obsessive thoughts and compulsive urges, which may make ERP therapy feel more manageable. Some people find it helpful to reduce (but not eliminate) their anxiety through medication before starting ERP, but the right approach varies depending on the individual’s needs and treatment plan.
Bottom line
Managing OCD can feel overwhelming, but there are clinically-proven treatments available. Medications like Lexapro may play an important role in reducing symptoms, especially when paired with ERP therapy.
Every treatment plan is unique, and finding the right approach takes time. If you’re considering OCD medication as part of your treatment plan, speak with a licensed healthcare professional.
Key takeaways
- Lexapro (escitalopram), an SSRI, has proven effective in reducing OCD symptoms.
- OCD treatment often requires higher doses of Lexapro than those used for depression or anxiety, and it may take 6 to 12 weeks to see meaningful results.
- While Lexapro may alleviate obsessive thoughts and compulsions, it’s most effective when combined with exposure and response prevention (ERP) therapy, a specialized form of cognitive behavioral therapy (CBT) designed to treat OCD.
- Medication for OCD, including Lexapro, should always be closely monitored by a healthcare provider to ensure safety and effectiveness.