OCD Medications: How Antidepressants and Antipsychotics Can Help

Obsessive-compulsive disorder (OCD) is commonly treated with both medication and cognitive behavioral therapy. Medications that target serotonin pathways in the brain, like antidepressants, are particularly effective in treating people with OCD—and if this doesn't work, adding on an antipsychotic medication may be useful.

Let's take a look at the various medications used to treat OCD, including antidepressants and antipsychotics, that have been found to be effective in scientific studies.

Antidepressant OCD Medications

Around 70% of people with OCD experience some benefit from medication, with a symptom reduction rate between 40% to 60%. The most commonly prescribed type of antidepressant medication used to treat OCD is selective serotonin reuptake inhibitors (SSRIs).

Though traditionally used to treat depression, research has shown SSRIs to be the most effective medications for OCD, as well. Their positive effects can often be felt within two weeks of starting treatment.

If you do not respond to SSRIs, your doctor may prescribe Anafranil (clomipramine). Anafranil is a tricyclic antidepressant that is FDA-approved to treat OCD. Anafranil may cause side effects such as dry mouth, drowsiness, gastrointestinal issues, and trouble concentrating, among others.

Dosages

When treating OCD, SSRI doses are usually higher than those used for depression. Your primary care provider will probably start you on a low dose to begin and increase it if needed.

The daily dosing of SSRIs for OCD are as follows:

Check your prescription and talk to your physician to make sure you are taking the right dose for you. If after about 12 weeks your symptoms haven't decreased by about 40% to 50%, they may either adjust your dosage or start you on a different SSRI.

Off-Label SSRIs for OCD

Most people will experience at least some symptom relief after taking the antidepressants approved for OCD. Many still have residual symptoms, though.

In these situations, healthcare professionals may prescribe other medications "off-label" to try to find a more effective treatment. Two SSRIs—Celexa (citalopram) and Lexapro (escitalopram)—are sometimes prescribed off-label to treat OCD.

Side Effects

Like all psychiatric medications, antidepressant OCD medications may cause side effects. Common side effects of antidepressants include:

• Blurry vision
• Dry mouth
• Fatigue
• Gastrointestinal issues
• Headaches
• Trouble sleeping
• Weight gain

In many cases, these side effects decrease over time as your body adjusts to your medication. Always talk to your physician about the side effects you are experiencing and any concerns you may have.

When Antidepressants Aren't Enough

About 40% to 60% of people with OCD do not show a satisfactory response to SSRIs alone. Generally speaking, "response" is defined as a 35% reduction in the Yale-Brown Obsessive-Compulsive Scale (a test that rates the severity of OCD symptoms; Y-BOCS).

If after 10 to 12 weeks SSRIs aren't significantly alleviating your symptoms, your physician may decide to try augmenting your SSRI with an antipsychotic. Augmenting involves adding a medication, in this case an antipsychotic, to improve the effectiveness of the original treatment.

Antipsychotic OCD Medications

Two types of antipsychotic medications can be used to treat OCD: first-generation and second-generation antipsychotics. Second-generation antipsychotics, also known as atypical antipsychotic medications, are usually chosen to augment SSRIs.

The following atypical antipsychotics have been found to work well:

• Abilify (aripiprazole)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)

Haldol (haloperidol), a first-generation antipsychotic, may also be used to augment SSRIs in people with OCD. Though Haldol can effectively treat OCD symptoms, it's been shown to be more likely to cause extrapyramidal side effects (drug-induced movement disorders) in some people than the atypical antipsychotics.

Dosages

There are no specific dosing recommendations for antipsychotic augmentation for OCD. Many experts believe antipsychotics should only be administered in low to medium doses. However, according to some studies, medium to higher dosages are more effective.

Below are some typical dose ranges for antipsychotic augmentation, although actual effective dosages can be different.

Experts do agree, however, that using an antipsychotic to augment OCD treatment is nothing like using it for schizophrenia or bipolar disorder. Usually, much lower doses can be used to help treat OCD. In the end, it is really up to your physician to decide the appropriate dose needed to treat your symptoms.

Side Effects

Antipsychotic medications also have the potential to cause side effects. Some of these include:

• Constipation
• Dizziness
• Dry mouth
• High cholesterol and blood sugar levels
• Jaundice
• Sedation
• Urinary retention
• Weakened immune system
• Weight gain
  

Timeline and Withdrawal

Don't expect antipsychotics to immediately impact your symptoms of OCD. You may notice improvements within the first few days of taking these medications. However, it usually takes several weeks to fully experience their benefits.

Some guidelines recommend you take an antipsychotic for at least one year after symptom remission. Discontinuing earlier than that may increase your chances of relapse.

OCD Discussion Guide

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