Obsessive-compulsive disorder (OCD) is most commonly treated with selective serotonin reuptake inhibitors (SSRIs), which help regulate serotonin levels. They tend to be effective, especially when combined with therapy, but come with risks.
Though the exact cause of OCD remains unknown, research suggests that imbalances in the neurotransmitter serotonin may at least in part contribute to its development. For this reason, first-line medications for OCD are selective serotonin reuptake inhibitors (SSRIs), commonly known as antidepressants.
Keep in mind that while effective, medication is most often recommended in combination with therapy like cognitive behavioral therapy (CBT) for the best results. These medications are only available by prescription, and their use should be monitored by a professional.
Here’s what else to know about OCD medication, including newer treatments on the horizon.
OCD medications list
Several types of medications are commonly prescribed for OCD, including :
1. Selective Serotonin Reuptake Inhibitors (SSRIs):
SSRIs are typically the first-line treatment for OCD . These medications work by increasing the availability of serotonin in the brain, which may help relieve OCD symptoms.
2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):
SNRIs work similarly to SSRIs but also increase the availability of norepinephrine in addition to serotonin, which may provide additional benefits for some patients.
3. Tricyclic Antidepressants:
Clomipramine is among the most researched and longest-used OCD medications. Though it’s FDA-approved to treat OCD, it’s not commonly recommended as a first-line treatment due to the risk of side effects. It is the only tricyclic antidepressant used to treat OCD.
4. Atypical Antipsychotics (used as augmentation):
Antipsychotics are often used as augmentation therapy when SSRIs alone fail to work. They influence dopamine in the brain, which may play a role in some OCD symptoms (specifically tic-related ones).
Do OCD medications really work?
According to a 2020 review , a wealth of evidence suggests SSRIs are effective for treating symptoms.
That being said, according to a 2010 review of several studies, about 40% to 60% of patients with OCD experience no or partial symptom improvement with a first-line drug like an SSRI. About 70% of patients with OCD will benefit from either medication or exposure and response therapy (ERP) . Those who do benefit from medication usually experience symptom improvement from 40% to 60%.
There’s less evidence on the effectiveness of other types of drugs for treating OCD. Talk with a doctor to see if medications could reduce your OCD symptoms.
What OCD medications are safe during pregnancy?
SSRIs are currently the most commonly used as well as the most commonly researched antidepressants during pregnancy and lactation. For this reason, their safety profile is more well-known than other drugs.
Current research has linked SSRI use during pregnancy to:
Keep in mind, however, that untreated depression during pregnancy is also associated with adverse outcomes, including premature birth, low birth weight, and perinatal mortality. Though depression and OCD aren’t the same condition, they do have similar effects on serotonin levels, which may make the decision of whether to take medication a careful risk-benefit analysis.
According to a 2023 review , sertraline has the most favorable safety profile of the SSRIs during pregnancy and lactation. Experts say this is due to its relatively low absorption into the placenta compared with other types. Citalopram is also known to have a relatively good safety profile for pregnant people.
Ultimately, the decision to take medication during pregnancy comes down to you and your doctor. Here’s what else to know about antidepressant use during pregnancy .
What OCD medications are safe for kids?
Antidepressants have been linked to an increased risk of suicidality in children and adolescents with obsessive-compulsive disorder, major depressive disorder (MDD), and other psychiatric disorders, especially during the first few months of treatment.
In a large older study from 2009 of 24 trials of over 4,400 patients taking various antidepressants (including SSRIs), the average risk was found to be 4% for this group, or twice the placebo risk of 2% for those not taking antidepressants.
For that reason, the Food and Drug Administration (FDA) has mandated boxed warning statements for these drugs and strongly recommends that:
- Those considering antidepressant use for children or adolescents must balance the risk of suicidality with the clinical need.
- Children undergoing drug therapy be closely observed for any warning signs of clinical worsening, suicidality, or unusual behavior changes.
Ultimately, the decision to use OCD medications in children and adolescents comes down to you, your child, and their doctor. Here’s what else to know about the safety of antidepressants for children .
Common side effects of OCD medications
Common side effects of SSRIs and other medications commonly prescribed for OCD include:
SSRIs are also linked to an increase in suicidality in all individuals, but especially children and adolescents.
You’re not alone
If you’re experiencing suicidal ideation and need someone to talk with, you can reach out to the Suicide and Crisis Lifeline online or by calling 988 in the United States. Counselors are available 24/7 to listen and help you find the resources you need.
If you feel that your OCD medication is causing your suicidal thoughts, it’s important to talk with your doctor before you stop taking them. Quitting psychiatric medication “cold turkey” could cause an additional increase in symptoms.
Safety tips for OCD medications
The dosage and other recommendations for your OCD medication will come with detailed instructions from your doctor. It’s important to follow them closely. Here are some additional tips to help improve safety outcomes when taking OCD medication, including:
- Discuss potential interactions and allergies with your doctor.
- Make sure they are aware of your other medications and conditions.
- Take OCD medication consistently at the same each day and as instructed by your healthcare professional.
- Use alarms or electronic pill bottles to avoid double-dosing or skipping doses.
- If you miss a dose, consult your healthcare professional for next steps.
- Let your doctor know about any concerning side effects right away.
- A symptom journal may help you keep track of how these medications are affecting you.
- Avoid consuming food or drinks high in vitamin C within 2 hours of your OCD medications.
- Avoid taking dietary fiber or activated charcoal supplements within 2 hours of your OCD medication.
- Some SSRIs may increase the risk of heatstroke; take precautions to stay hydrated and out of direct sunlight on warmer days.
- Don’t stop taking medication abruptly, even if you start to feel better.
Remember that if your child is taking medication for OCD, close monitoring is vital due to an increased suicide risk when taking SSRIs, especially during the first few months of treatment.
Keep in mind that medication isn’t always required for the successful treatment of OCD, and studies show that these medications work best combined when with therapy like CBT for best results.
Learn more about all your options for therapy with OCD here.
Takeaway
OCD medications, particularly SSRIs, can significantly improve symptoms for many individuals with OCD. However, they may come with side effects and are most effective when used in combination with therapeutic approaches like ERP and CBT .
It’s best to always work closely with your healthcare professional to find the most appropriate treatment plan for your individual needs and to manage any potential side effects. OCD medications are only available via prescription.
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