How medication is used in OCD treatment
Exposure and response prevention (ERP) therapy and certain medications are both considered first-line treatment options for OCD—sometimes, pairing the two approaches together can be even more effective.
Obsessive-compulsive disorder (OCD) can be extremely debilitating, but it's also highly treatable. Consistently, the most successful form of psychotherapeutic treatment has been shown to be exposure and response prevention (ERP) therapy, which is effective in around two thirds of people with OCD who complete treatment and can lead to significant results in as little as 12 weeks.
For some people with OCD, ERP therapy is most effective when accompanied by prescribed medication. This may be due to the severity of their symptoms, their individual psychology and neurobiology, or other conditions that impact them at the same time, such as major depressive disorder. For these people, a treatment plan developed by trained professionals combining therapy with medication can provide the best chance at long-term recovery.
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Are medications used to treat OCD?
While the most effective form of therapy for OCD is ERP therapy, some treatment plans use medications alone, and the most successful approach for many—but not all—is a combination of the two.
ERP works by desensitizing people to their obsessions and increasing their tolerance for distress and uncertainty related to their OCD fears. People engage in planned exposures to their fears, and their therapist guides them to resist doing compulsions that reinforce their fears. Learn more about ERP.
While many people achieve life-changing results with ERP alone, many clinicians have consistently found that medications can be extremely beneficial—or even necessary—for people who aren't able to make progress in ERP, by reducing their anxiety and distress to more manageable levels so they can engage fully in exposure exercises.
Combining medication with ERP therapy
Combining ERP with medication is an evidence-based approach: 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.
When people take medication and do ERP therapy together, their OCD symptoms decrease by an average of 40-50%. In certain cases, some who do both treatments may be able to discontinue their medication with the guidance of their prescriber and therapist. In these cases, doing ERP before discontinuing medication—and, for some, continuing ERP therapy afterwards—may help prevent a relapse in symptoms.
It's important for both ERP therapists and medication prescribers to have training in OCD, because the wrong treatment can be ineffective—or in some cases, even harmful.
Common medications used to treat OCD
Selective Serotonin Reuptake Inhibitors (SSRIs)
The medications most often used to treat OCD are selective serotonin reuptake inhibitors (SSRIs). This name refers to an effect that the medications have on serotonin, an important chemical in the brain.
The immediate effect of SSRIs is to increase the amount of serotonin between nerve cells in certain parts of the brain. However, there is no conclusive evidence of a serotonin deficiency in people with OCD, so the benefits of SSRIs in OCD treatment aren't thought to be a result of this immediate effect. Rather, they most likely work as a tool to alleviate OCD symptoms through gradual changes that occur over time in response to these increased serotonin levels.
When working with a licensed clinician to choose the right medication, it's important to recognize that among SSRIs, all of the recommended medications used to treat OCD are equally likely to work, on average, and no one medication is better or worse than another overall. On an individual level, however, it's possible that one SSRI could work better for one person than another, and people may tolerate certain medications better than others. It is impossible to predict with certainty how an individual will respond to a specific medication, so decisions on which medication to use are typically made based on one's susceptibility to side effects, their family history, and any other medications they may be taking.
Specific SSRIs commonly used in OCD treatment include:
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
Tricyclic Antidepressants (TCAs) and Atypical Antipsychotics
While SSRIs are typically the most effective medications used in OCD treatment, they may not work well for everyone. In these cases, other types of medication may be used, such as a specific tricyclic antidepressant (TCA) called clomipramine, which has been used for OCD treatment since the 1980s.
Or, if someone has a partial response to an SSRI or clomipramine, atypical antipsychotics can sometimes be effective when added to these medications. They do not tend to have beneficial effects when taken alone, but when they are carefully prescribed (usually at lower doses for OCD than for other conditions), they can lead to symptom reduction, sometimes in a relatively short time period.
There is always hope—even if other treatments haven't worked, it's still possible to find a plan that allows you to conquer OCD.
Jamie Feusner MD, he/him
Chief Medical Officer, NOCD
How to know if medication is the right approach
While medications can be important, they are not always necessary for full recovery. To explore whether medication is the right approach, people should seek guidance from a licensed prescriber. The IODCF provider directory* is a resource for finding OCD specialists by location. NOCD does not prescribe medication directly, but there are 340+ specialty-trained therapists in the NOCD network who regularly refer people to qualified prescribers for medication management. To explore treatment options, book a call with our team
* Please note we cannot attest to the quality of care provided by clinicians in this directory
Other emerging treatment options for OCD
For those who don't respond as well to 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 ongoing 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 should 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, that can help them conquer OCD.
How long do people typically take medication for OCD?
Medication plans involve a significant period—possibly several months—before people reach what's known as a therapeutic dose, or a dose needed in order to have the intended effect. It typically takes a year or two of treatment and success in experiencing minimal OCD symptoms before people are ready to consider decreasing or eventually stopping medication with the guidance of their treatment team. Some people, however, have a very positive experience with medications and choose to take them for many years—or even throughout their lives.
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