Can OCD be treated without medication? What experts say

Many people successfully treat OCD with exposure and response prevention (ERP) therapy without medication. For others, combining medication with therapy is a more effective way to manage their symptoms. 

Getting a diagnosis of obsessive-compulsive disorder (OCD) often brings up a lot of questions: What does this diagnosis mean for my daily life? How will OCD affect my relationships? What treatment options are available? And, for many people, the biggest question of all—do I need medication? Or is there a path without it?

In this article, we’ll explore the role of medication, its limitations, and how ERP can often treat OCD on its own. Remember, reaching out to a mental health professional can help you make the choice that’s right for you.

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How is OCD treated?

Typically, OCD is treated using exposure and response prevention (ERP) therapy, a specialized form of cognitive behavioral therapy (CBT) created to disrupt the cycle of obsessions and compulsions. Unlike other forms of CBT, which are less effective at reducing OCD symptoms—or in some cases actually make them worse—ERP has been shown to be highly effective for the majority of people who use it.

ERP works by helping you identify and purposely trigger your obsessions while resisting the urge to respond with compulsions. By working with a trained therapist who specializes in OCD, you rank your fears from least to most stressful. To start, your therapist will generally encourage you to face a less stressful trigger. 

Let’s say, for example, you avoid knives because you have intrusive thoughts of stabbing people. You may start ERP by simply looking at a picture of a knife. The discomfort will likely come up, but you learn to tolerate it instead of fighting it. When nothing bad happens (or you realize you handle the discomfort better than you expected) you gradually become more comfortable and progress to more challenging triggers.

The more you face your fears, the more your brain learns that there is nothing to fear and that compulsions are not necessary to keep you safe. Eventually you can reach a point where you can be in a room with knives – or even use them to prepare dinner – without feeling overwhelming anxiety.  

As NOCD therapist April Kilduff, LMHC, LCPC, LPCC, explains, “Often we will just try ERP first without meds and see if it gives you the progress you need—and for a lot of people, it’s all they need to be in recovery.” It’s important to note that ERP can be challenging, and requires intention and commitment. Sometimes, ERP will need to be supplemented with other treatments, which can include medication, acceptance and commitment therapy (ACT), or peer support groups.

Can you treat OCD on your own?

ERP is designed to be done with a trained mental health professional, so attempting to treat OCD on your own is generally not recommended, says NOCD therapist Tracie Ibrahim, MA, LMFT, CST. Research shows that only about 4% of people with OCD recover without professional support. 

Working with a therapist ensures that exposures – the exercises that help you face fears and leave your comfort zone – are safe, targeted, and effective. Without guidance, you might tackle the wrong exposures, push yourself too far too soon, or miss critical steps in the treatment process. 

“You may actually do more harm than good if you are not working with a therapist who is evaluating your needs and progress,” Ibrahim explains. “Therapists assign ERP homework that is appropriate so that you can continue getting the benefits of OCD outside of sessions, and learn how to incorporate it into daily life when no longer in therapy.”

Any decision to use any form of OCD treatment or medication should be made in consultation with a provider trained in treating OCD. They can help assess your symptoms and guide you toward the most appropriate, effective treatment plan.

Medications for OCD

Some people find that supplementing ERP with medication can make the process more manageable, especially when symptoms feel overwhelming or progress is slow. Medications don’t cure OCD, but they can provide enough symptom relief to help people fully engage in therapy and begin breaking free from the OCD cycle.

Let’s take a closer look at the types of medications commonly used for OCD, how they work, and how they can support ERP therapy.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are the most prescribed class of medication for OCD. They are also used to treat depression, anxiety, and post traumatic stress disorder (PTSD). Research shows SSRIs reduce OCD symptoms for about 40 to 60% of people who take them.

TCAs

Tricyclic antidepressants (TCAs) are another type of medication that may be used to treat OCD. They work by affecting both serotonin and norepinephrine, a neurotransmitter involved in the body’s “fight-or-flight” response. 

“Everyone is different,” Ibrahim says. “For some people, medication does not help. For others, it may be helpful in reducing symptoms, but you still need ERP therapy to help you learn how to react when obsessions come up.”

How medications for OCD can help

Medications can help some people with OCD tackle the challenges of ERP therapy in several ways:

• Lowering anxiety. Many people with OCD experience high levels of anxiety, which can make ERP therapy feel overwhelming. Medications can help take the edge off anxiety, making it easier to tolerate exposure to feared situations or objects—an essential part of ERP.
• Improving the ability to resist compulsions. One goal of ERP therapy is learning to resist compulsions when obsessions arise. Medications can help reduce the frequency and intensity of obsessions and compulsions, which may make this process more manageable.
• Supporting cognitive flexibility. People with OCD often struggle with rigid thinking patterns. Some medications can improve cognitive flexibility, making it easier to learn, apply, and stick with new coping strategies during ERP therapy.
• Improving mood. OCD can be highly distressing and often co-occurs with depression or other mood disorders, which can affect motivation and follow-through. Medications may help improve mood and reduce the overall symptom burden, making it easier to engage in ERP.

However, no medication addresses the root cause of OCD. Whether or not you take medication, therapy is usually needed to achieve and maintain lasting results.

If you decide to take medication for OCD, that doesn’t mean you have to take it forever. “Medication makes some patients more able and willing to step in to do some of the scary tasks that we ask people to do in ERP,” says Kilduff. Once patients get the hang of ERP and are in recovery, many patients can work with their doctors to taper off the medication.

“We see whether the successes and gains they got in ERP are maintained or if they kind of start to dwindle as the dose goes down” explains Kilduff. While some people may need medication long-term, many people “realize they can get off the medication and use what they learned with ERP to stay in recovery and to handle lapses when they come up.”

Limitations of OCD medications 

While medication may help you manage OCD symptoms, they have several limitations when used without ERP. 

First, medication targets symptoms rather than the underlying psychological factors that drive OCD. As a result, medication alone might not provide long-term relief from OCD symptoms. 

“I’ve worked with people who will start with medication because it requires the least effort,” says Kilduff. “They might have a little bit of relief, but not the complete recovery they hoped for, and so, at that point, their only option is to reach out and do ERP therapy.”

Second, medication can have side effects, which some people may not be able to tolerate. Some people may also experience withdrawal symptoms when discontinuing their medication.

“Medications don’t work for everyone,” Ibrahim said. “People with severe OCD symptoms may require higher doses of medication or a combination of drugs. Additionally, some people may not respond to medication at all.”

Alternatives to medication for OCD 

Although the first-line treatments for OCD—ERP therapy and medication—are often needed to manage symptoms, many people also use additional strategies to support progress and maintain improvements over time.

To support treatment, a therapist may recommend strategies such as:

• Acceptance and commitment therapy (ACT). ACT is a form of behavioral therapy that encourages you to accept your thoughts, emotions, and urges as neutral, rather than as good or bad. Learning to do this might help you do ERP more easily.
• Healthy lifestyle practices. One study found that OCD patients who exercised more often had better improvement in OCD symptoms during therapy. Health promoting habits also include having a balanced diet, prioritizing seven to nine hours of sleep each night, and managing stress through mindfulness, meditation, or yoga. 
• Family or community support. A 2014 study found that including family members in your treatment can have a large impact on OCD symptoms and overall functioning. “Getting family involved can be helpful, since you’ll have other people help hold you accountable,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD.
• Support groups. Having OCD can be isolating when you feel like you’re the only one experiencing the cycle of obsessions and compulsions. It’s comforting to spend time with people who understand and support you, and it can motivate you to stay on top of ERP. “That’s why we have so many support groups at NOCD,” says Kilduff. “Those can be great touch points in between therapy sessions.”
• Deep transcranial magnetic stimulation (TMS). This non-invasive treatment uses electromagnetic pulses to stimulate nerves in the brain. Deep TMS is not a stand-alone treatment and may only be suggested if medications and other therapies have not been successful.  

Bottom line

OCD is a highly treatable condition, and recovery is possible with or without medication. Many people find success with ERP therapy alone, while others benefit from adding medication to their treatment plan.

What matters most is finding an approach that works for you. A therapist specializing in OCD can help you explore your options and guide you toward lasting relief. With the right support, managing OCD—and living a fulfilling life—is possible.

Key Takeaways

• OCD is highly treatable without medication. Many people find relief through exposure and response prevention (ERP) therapy, which is often effective even without medication.
• Medication can be helpful but isn’t required. Medications like SSRIs or TCAs may reduce symptoms and make ERP more manageable for some people.
• Treatment should be personalized. Everyone’s experience with OCD is different, so working with an OCD specialist can help you find the right combination of supports.
• Support matters. Therapy, family involvement, and support groups can all help you stay engaged in treatment and feel less alone.