Medicines for the treatment of OCD I Psych Central

Medications can help reduce the intensity of OCD symptoms by keeping neurotransmitter levels constant.

Medications often come with potential side effects, and sometimes the list of what “could” happen seems more daunting than what you are already experiencing.

ThisIt is natural to be apprehensive at the start of a treatment.

But for the majority of people with OCD, medication can help reduce symptoms and improve quality of life.

Obsessive-compulsive disorder is a mental health condition defined by uncontrollable obsessions, compulsions, or both.

Obsessions can be thoughts, images, or urges that repeat themselves over and over again and feel like theyare out of your control. Theyare often unwelcome and intrusive, and they can be accompanied by a number of negative emotions, such as fear, anger or self-doubt.

Compulsions are also repetitive thoughts or behaviors, but the purpose of a compulsion is to neutralize the obsession.

Obsessions and compulsions can impact your daily functioning in important areas of your life, such as school, work, or relationships.

Medications can be used to help manage obsessive-compulsive processes in the brain.

The majority of prescriptions for this purpose belong to a class of drugs called selective serotonin reuptake inhibitors (SSRIs), although other drugs that target serotonin can be used, including:

  • serotonin reuptake inhibitors (SRIs)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)

Some of the more common medications for OCD include:

Anafranil is the most studied and widely used OCD drug, according to the International TOC Foundation (IOCDF).

Of the five medications approved by the Food and Drug Administration (FDA) to treat OCD, Anafranil is the only SRI, although it is more commonly referred to as a tricyclic antidepressant (TCA).

The four FDA-approved SSRIs include:

  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluvoxamine (Luvox)
  • fluoxetine (Prozac)

Medications that are sometimes prescribed but not approved by the FDA for the treatment of OCD include:

  • venlafaxine (Effexor)
  • duloxetine (Cymbalta)
  • escitalopram (Lexapro)
  • citalopram (Celexa)

These drugs are considered “without label” when prescribed for OCD, meaning they are not yet FDA approved to treat this condition, but may still be effective for it.

Most medications come with a recommended dosing protocol. A medical or mental health professional can adjust your individual dose based on your needs, improvement in symptoms, and tolerance levels.

Standard dosages in milligrams per day (mg/day) for OCD medications may include:

  • venlafaxine (Effexor): up to 375 mg/day
  • duloxetine (Cymbalta): up to 120 mg/day
  • clomipramine (Anafranil): up to 250 mg/day
  • escitalopram (Lexapro): up to 40 mg/day
  • citalopram (Celexa): up to 40 mg/day
  • sertraline (Zoloft): up to 200 mg/day
  • paroxetine (Paxil): 40 to 60 mg/day
  • fluvoxamine (Luvox): up to 300 mg/day
  • fluoxetine (Prozac): 40 to 80 mg/day

Many OCD medications are traditionally known as antidepressants, but they can also help relieve OCD symptoms.

The exact cause of OCD remains under investigation, but experts suggest that imbalances in the neurotransmitter serotonin may play a role in the obsessive symptoms of OCD.

A 2015 study found that low serotonin levels can contribute to obsessions.

IRSs, SNRIs and SSRIs work by blocking the reuptake of serotonin in neurons (nerve cells), which means that the amount of serotonin available increases.

Most prescription medications come with a list of possible side effects.

Common side effects of antidepressants include:

  • sexual dysfunction
  • headache
  • appetite changes
  • dizziness
  • diarrhea or constipation
  • nausea
  • restless feeling
  • anxiety
  • sleep disorder
  • weight changes
  • sweat
  • dry mouth
  • vision changes
  • increased heart rate

A 2020 cohort study suggests that long-term use of antidepressants may increase your risk of type 2 diabetes. But more research is needed.

Other less common but potentially serious side effects may include:

You may experience some side effects when you first start taking medication, but these are usually temporary. Your body may take time to adjust to a new medication.

If your side effects last for several weeks without improvement or if you are concerned, consider contacting your doctor immediately. Your doctor will work with you to assess what is going on and make any necessary adjustments.

Not everyone can take antidepressants.

If you are pregnant or planning to become pregnant, discuss any potential problems with taking an antidepressant with your doctor.

Prozac, Luvox and Zoloft have been FDA approved for use in children over 8 years of age. But some antidepressants may not be suitable for all children.

Antidepressants may not be recommended if you live with conditions such as:

Antidepressants may not be recommended or dose adjustments may be needed if you:

  • taking other drugs that increase serotonin
  • operate heavy machinery (as drowsiness or vision changes may interfere with this)
  • consume alcohol
  • take herbal supplements such as St. John’s wort

SSRIs and other traditional OCD medications work for about half of people who take them, according to a Report on studies 2010.

When antidepressants do not have enough impact, additional therapy with antipsychotics or other classes of drugs may be recommended.

Taking an antipsychotic doesn’t mean you’ve lost touch with reality.

Antipsychotics influence the neurotransmitter dopamine in your brain. Like serotonin, dopamine is becoming an important neurotransmitter involved in OCD symptoms, according to a 2020 review. However, further research is needed.

Common antipsychotics that may be used include:

When should I take this medicine?

OCD medications are meant to be used on a regular schedule, not just when you experience symptoms.

These drugs work by keeping serotonin at a constant level. Following them as regularly as possible is often an important factor in their success.

Your doctor will help you determine the dose and frequency that is right for you and your symptoms.

If you miss a dose, they will advise you on what to do.

Doubling up on medication or skipping doses without medical advice can cause symptoms to return or worsen and increase the likelihood of negative side effects.

What if I have an obsessive fear of drugs?

Living with OCD can mean having an obsession that revolves around taking medication.

If so, therapy may be the first step in helping you overcome your fear of medication.

Exposure Response Prevention (ERP) therapy, a form of cognitive behavioral therapy (CBT), is considered a first-line treatment option for TOC.

ERP involves progressive exposure to elements of your environment related to your obsessions.

With guidance from a mental health professional, you can learn new ways to deal with the stress that leads to obsessions without creating compulsions.

How long will I have to take medication?

There is no definitive timeline for how long you might need to take OCD medication.

Medication is recommended for a period of at least 3 months, depending on research since 2010. It usually takes about this time to see a reduction in symptoms and to determine if this type of medication and dosage will be helpful for your symptoms.

If your symptoms improve, you will continue with a maintenance dose. A maintenance dose is a dose that you take regularly to maintain drug levels and effects.

Medications are usually continued for 1 to 2 years before the dose is gradually reduced, ie tapered off. If you experience a recurrence of symptoms, you may need to use the drug indefinitely or indefinitely.

What if I can’t afford to buy my medication?

The cost of medication is a concern for many people.

Consider asking your doctor for free samples. These may be offered for a short time if you cannot afford a prescription.

If cost remains a challenge, you can find help through state prescription programs available at your local pharmacy.

To learn more about the support options available, you can consult the medicine aid tool online or call 888-477-2669.

The federal government also offers prescription assistance programs. You can learn more about them by visiting the Centers for Medicare and Medicaid Services (CMS).

If you or someone you know is living with OCD, support is available.

The IOCDF offers a list of support groups near you. You can also consult the IOCDF list support groups online or by phone to help. Other resources offered by the IOCDF include:

If you would like to know more about the resources available, you can consult our OCD resources directory.

Although they have potential side effects, the drugs can help improve OCD symptoms in many people.

A medical or mental health professional can work with you to decide which medications are right for you and your symptoms.

SSRIs, SNRIs, and IRS are the most common drug classes used to treat OCD symptoms.

If your symptoms do not improve or seem resistant to first-line approaches, your treatment may be supplemented with other medications, such as antipsychotics.

Medications for OCD are almost always recommended in combination with psychotherapeutic approaches such as ERP.

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