There are multiple medications used to treat Obsessive Compulsive Disorder (OCD).
The first line treatment is elective serotonin reuptake inhibitors (SSRIs).
Here's an explanation of types of OCD medications, effectiveness, side effects, and how to choose a medication that's right for you.
Effectiveness of SSRIs in OCD treatment
Medication management with has been shown to be an effective treatment for OCD.
“[SSRIs] have been shown to help as many as 60% of individuals and are widely available and generally well-tolerated,” says Dr. Storch, head of psychology at Baylor College. “Their combination is recommended among those most severely impacted by OCD.”
Research suggests that for individuals with mild OCD, Exposure and Response Prevention therapy alone may suffice in providing relief. Combined therapy with ERP and an SSRI may benefit those who have inadequate responses to ERP as well as those with severe OCD.
How SSRIs work for OCD
SSRIs work by directly affecting serotonin, a chemical messenger, in the brain. Although typically used as an antidepressant, using higher doses of SSRIs than what is normal for depression or anxiety can be successful in reducing symptoms of OCD.
FDA approved SSRIs to treat OCD
The following four SSRIs have shown promising data, and are FDA-approved to treat adults with OCD:
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Citalopram (Celexa)
Research suggests that for individuals with mild OCD, ERP alone may suffice in providing relief. Combined therapy with ERP and an SSRI may benefit those who have inadequate responses to ERP as well as those with severe OCD.
Side effects of SSRIs
The most frequently reported side effects of SSRIs are gastrointestinal (GI) toxicities, including nausea, diarrhea, heartburn, and cramping. Other common side effects include fatigue, insomnia, weight gain, and sexual dysfunction.
SSRIs have vastly lower side effects than older classes of antidepressants because they are selective at certain receptors. Older medications such as fluoxetine and sertraline are associated with a higher prevalence of these side effects.
It's important to weigh the benefits and side effects when discussing medications options with your psychiatrist.
Other medications for the treatment of OCD
While SSRIs are the most common medications used for the treatment of OCD, there are a number of agents from other classes used as well.
Clomipramine is an antidepressant from a class known as the tricyclic antidepressants. Like SSRIs, it also affects serotonin. Because its side effects are generally less tolerable than SSRIs, they are not considered first-line therapy.
Risperidone, haloperidol, olanzapine, and quetiapine are antipsychotic medications that are used in certain cases in combination with an SSRI to supplement the effect of SSRIs.
Memantine, amantadine, topiramate, and pregabalin affect glutamate levels and are among the many candidates that may be helpful in the future treatment of OCD.
Choosing a medication for OCD
When you meet with your psychiatrist or psychiatric nurse practitioner (professionals who are trained to prescribe and mange psychiatric medications), you can discuss whether or not medications are the right treatment for you. Your provider will be able to explain the side effects and benefits of each individual treatment.
We do know that each of these medications affect a chemical in the brain called serotonin. Serotonin is used in the brain as a messenger. International OCD Foundation. (2018). Medications for OCD.
The improved tolerability of the SSRIs is attributable to their selectivity and to their absence of interactions with other receptors. Ferguson, J. M. (2001, February). SSRI Antidepressant Medications: Adverse Effects and Tolerability. Retrieved August 17, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/
Glutamatergic agents are among the most exciting new candidates in the treatment of OCD. Ferguson, J. M. (2001, February). SSRI Antidepressant Medications: Adverse Effects and Tolerability. Retrieved August 17, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/