Let’s be real—if there were a pill you could take to make your OCD go away, you would probably know about it already. Because obsessive-compulsive disorder (OCD) is such a complex condition, it requires specialized treatment. In the words of OCD specialist Kimberly Quinlan, LMFT, “Medication alone is not a silver bullet for OCD recovery.” However, medication can be helpful as part of a broader treatment plan for OCD, particularly when combined with an evidence-based therapy called exposure and response prevention (ERP) therapy.
While OCD is not a condition that gets better on its own, it is highly treatable. For some people, working with a therapist who specializes in exposure and response prevention therapy is what keeps their OCD symptoms manageable. For others, especially people with co-occurring mental health conditions, a treatment plan that combines therapy and medication is what provides the best outcomes.
The best way to find out if medication makes sense for your treatment plan is to speak with a healthcare provider who specializes in OCD. In the meantime, we can give you an overview of the types of medications commonly used to treat obsessive compulsive disorder.
Prescriptions for OCD: What medications can help?
OCD medication may be added to your treatment plan for a number of reasons, including the severity of your OCD symptoms, whether or not you have co-occurring mental health conditions such as severe depression, your own unique psychology and neurobiology, and of course, your personal choice.
While many people achieve life-changing results solely through exposure and response prevention therapy, clinicians have consistently found that medications can be extremely beneficial for people who are having a hard time making progress in ERP. OCD medications help by reducing anxiety and distress to more manageable levels so that full participation in ERP exercises is easier.
Categories of medications used for OCD
Selective serotonin reuptake inhibitors (SSRIs)
The most commonly prescribed medication for OCD is a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). The immediate effect of SSRIs is to increase the amount of serotonin—a chemical that regulates mood and behavior—between nerve cells in certain parts of the brain.
Because there is no conclusive evidence of a serotonin deficiency in people with OCD, SSRIs most likely work through more gradual changes that occur as a result of higher serotonin levels. SSRIs are also frequently prescribed for anxiety and depression, so for people with OCD that have other mental health conditions, these medications might be especially helpful.
“When you take SSRIs for anxiety or depression, it tends to work for most people within two to four weeks,” says Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD. “With OCD, it usually takes anywhere from about six weeks to about 12 weeks to start working. There’s also a chance that the drugs might not work sufficiently. At that point, a provider might prescribe another type of SSRI or something else entirely.”
Feusner also notes that SSRIs are prescribed at higher doses when being used to treat OCD, compared with the dosage for generalized anxiety disorder or depression.
Here are some specific SSRIs that are commonly prescribed for OCD:
- Fluoxetine (Prozac) for adults and children 7 years and older
- Fluvoxamine (Luvox) for adults and children 8 years and older
- Paroxetine (Paxil) for adults only
- Sertraline (Zoloft) for adults and children 6 years and older
- Celexa (citalopram) for adults only
- Lexapro (escitalopram) for adults and children 12 years and older
Tricyclic antidepressants (TCAs)
TCAs are antidepressants that enhance communication between neurons in the brain. Clomopramine—the TCA most often prescribed for OCD—was created in 1964 to treat depression, but 20 years later researchers discovered that it was also effective for OCD.
Clomopramine works by slowing the rate of reabsorption of serotonin and norepinephrine in the brain, allowing the two chemicals to stay between nerve cells longer. Over several weeks, this can boost communication in these cells, which can improve mood, reduce symptoms of depression and anxiety, and minimize the intensity and frequency of obsessions and compulsions in people with OCD.
- Clomipramine (Anafranil) for adults and children 10 years and older
Atypical antipsychotics
If the term “antipsychotic” gives you pause, that’s understandable. Though originally approved for schizophrenia and bipolar disorder, the versatility of these drugs has led to its use in treating various mental health conditions, including major depressive disorder and, in some cases, OCD.
Atypical antipsychotics work by modulating certain neurotransmitters in the brain, which can stabilize mood.
- Abilify (aripiprazole) for adults and children 6 years and older. Note the aripiprazole is still considered “off-label” for OCD in the US, as it does not have an FDA indication for OCD specifically.
Is there one best medication for OCD?
Because everyone reacts to medications slightly differently, there’s no single best prescription for OCD. If you are interested in incorporating medication into your OCD treatment, it’s important to know that it can take some time to find the right treatment and dosage.
When medications are used in OCD treatment (and when they’re not)
Unlike exposure and response prevention therapy, medication alone is unlikely to lead to full recovery. But the majority of people find the greatest success when combining medication management with ERP therapy.
In a randomized trial of patients who benefited from OCD medication, one group that didn’t experience sufficient benefits from medication alone added ERP, while the other group did stress management training for 17 weeks. Those who did ERP therapy experienced over three times the reduction in symptoms of the other group.
According to an NOCD community member, a Prozac prescription helped address some of the anxiety related to her OCD. “In my experience so far the medicine doesn’t fully stop OCD but it helps to start the journey toward healing,” she wrote.
How to get a prescription for OCD medications
Although any licensed doctor can legally prescribe any of the drugs listed above, it’s most helpful to work with a board-certified psychiatrist who has training and experience treating OCD. That’s because OCD specialists will have a more in-depth understanding of your symptoms and which medications could be most effective.
The IODCF provider directory is a resource for finding OCD specialists by location, and the hundreds of trained OCD specialists in the NOCD Therapy directory regularly refer therapy members for medication management with trained providers.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
OCD Medication: What to consider before taking drugs to treat your condition
First of all, it’s important to remember that even if you decide to take medication for OCD, it doesn’t mean you have to take it forever. “Medication makes some people more able and willing to step in to do some of the scary tasks that we ask people to do in ERP,” says NOCD therapist April Kilduff, LMHC, LCPC, LPCC. Once patients get the hang of ERP and are able to manage their symptoms, many of them can work with their doctors to taper off the medication.
Medication makes some people more able and willing to step in to do some of the scary tasks that we ask people to do in ERP.
“We see whether the successes and gains they got in ERP are maintained or if they kind of start to dwindle as the med goes down.” explains Kilduff. While some people may need medication long-term, many people “realize they can get off the med and use what they learned with ERP to stay in recovery and to handle lapses when they come up.”
Also, it’s important to consider that medications have possible side effects, and that some OCD patients have a fear of taking pills, both of which may impact their ability to take their prescription. Speaking with a licensed professional who has specialized training in OCD is the best way to identify these side effects and triggers, and to determine what’s best for you.
Does OCD medication have side effects?
Every medication comes with potential side effects. Just because a side effect is listed on a prescription doesn’t necessarily mean it will impact you. Many of the common side effects from psychiatric medications diminish over time—but if you do experience any symptoms, it’s important to let your healthcare provider know. Keeping an open line of communication with your doctor and carefully following your dosage instructions are crucial.
Some common side effects across SSRIs, TCAs, and atypical antipsychotics include:
- Dry mouth
- Constipation
- Blurred vision
- Dizziness
- Drowsiness
- Weight gain
- Sexual dysfunction (i.e., difficulty becoming aroused or having an orgasm)
- Nausea
- Insomnia
What other treatment exists for OCD?
For the few who don’t respond as well to ERP therapy or common OCD medications, ongoing research is promising for new medications that affect the neurotransmitter called glutamate. Since there’s evidence that glutamate dysregulation could be involved in some OCD symptoms, there are clinical trials for medications that regulate it to treat OCD—you may even be eligible to participate.
People who have reached a point in treatment where evidence-based, first-line treatments haven’t been effective might consult with an experienced clinician about medication options like glutamate modulators or other treatments like transcranial magnetic stimulation (TMS). Even for those who haven’t responded to several types of treatment, it’s still possible to find one, or a combination of several, that can help them conquer OCD.
When building your OCD treatment plan, it’s good to incorporate the tools you find most helpful, whether it’s connecting with a supportive community, using mindfulness techniques, or physical movement. To build lasting resilience against OCD, however, ERP is the most effective treatment because it increases your ability to accept distress and uncertainty without relying on compulsions that only make your symptoms worse. Medication may also play a role in your OCD treatment, though ultimately that decision is up to you.