Most commonly, antidepressants are tried first. Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include: Clomipramine (Anafranil) for adults and children 10 years and older. Fluoxetine (Prozac) for adults and children 7 years and older.
Research clearly shows that the serotonin reuptake inhibitors (SRIs) are uniquely effective treatments for OCD. These medications increase and regulate the concentration of serotonin, a chemical messenger in the brain.
Exposure and response prevention (ERP) therapy is the best-proven behavioral strategy. During ERP, anxiety and obsession-inducing stimuli are systematically presented in a controlled environment and patients are prevented from engaging in their usual compulsions.
The selective serotonin reuptake inhibitors (SSRIs) are the mainstay of the pharmacological treatment of OCD.
First-line pharmacological treatment for OCD
SSRIs are associated with many adverse effects but are usually well tolerated. The only other medication which has shown to be consistently effective in OCD is the serotoninergic tricyclic antidepressant clomipramine.
Medication. Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms.
fluoxetine (Prozac) is an SSRI used to treat OCD and other mental health conditions including depression, certain eating disorders, panic disorder, and bipolar disorder. The medication comes as a capsule or tablet that is taken once daily, usually in the morning.
SSRIs have the advantages of ease of dosing and low toxicity in overdose. Available SSRIs include fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft). SSRIs are generally preferred over clomipramine in treating OCD.
SSRIs may have better efficacy than SNRIs in treating anxiety and OCD, but also have greater adverse events. The main adverse event of SSRIs is “activation,” but there are also others, including gastrointestinal symptoms. Early discontinuation is also an adverse event related to SSRIs.
The APA guidelines recommend the use of SSRIs in combination with antipsychotics for the treatment of schizophrenia with OCS/OCD. [67] SSRIs seem to be beneficial,[68] especially escitalopram at 20 mg/day,[69] but not in all cases.
The most common class of effective medications are antidepressants known as selective serotonin reuptake inhibitors (SSRIs). They include fluvoxamine (Luvox), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and paroxetine (Paxil).
We do not know exactly why SSRIs are helpful for some people with OCD, it's thought they might have an effect by altering the balance of chemicals in your brain, but what we do know is that they sometimes reduce the severity of obsessive-compulsive symptoms, by taking the 'edge' off some of the anxiety experienced.
Other medications that help in controlling intrusive thoughts are: Paroxetine (Pexeva)—prescribed only for adults. Fluoxetine (Prozac)—for children above seven years and also for adults. Sertraline (Zoloft)—for children above six years and for adults.
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, blurred vision, sedation, and rapid heartbeat. It can also lead to weight gain.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) that have been shown to be effective in treating OCD (although not FDA-approved) are: Venlafaxine (brand name Effexor) Duloxetine (brand name Cymbalta)
SSRIs like Zoloft, Prozac, and Paxil are typically the first medications recommended for OCD. These medications are considered to be generally safe.
But SSRIs are helpful for many people with anxiety-related disorders. For OCD, about 40-60% of people experience partial symptom reduction on an SSRI.
Medication for intrusive thoughts
Some recommended medications for OCD include: Clomipramine (Anafranil) Fluoxetine (Prozac) Fluvoxamine (Luvox)
A newly developed drug called truriluze is believed to be able to regulate glutamate, acting as a modulating agent for the neurotransmitter. Through glutamate's eventual effect on serotonin, this indirect route to OCD relief is considered a promising step toward more widespread symptom alleviation.
While individual effects vary, SSRIs are generally well-tolerated and effective. SSRIs also produce fewer side effects than tricyclics. While both antidepressants impact serotonin, tricyclics are less selective than SSRIs.
The gold standard treatment for OCD (obsessive-compulsive disorder) is a kind of CBT (cognitive behavioral therapy) called “exposure with response prevention,” or exposure therapy.
First choices in medications
Your health care provider may prescribe paroxetine (Paxil) or sertraline (Zoloft). The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.
Alternatives to Medication
These include Deep TMS, cognitive behavioral treatment (CBT), psychodynamic therapy, and surgical procedures.