Table of ContentsView AllTable of ContentsAntidepressantsAugmentationAntipsychotics
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What is the most important information I should know about OCD medications?Tell your physician about any medications, supplements, or substances you are currently taking before starting a new OCD medication.Never stop taking your medication suddenly; doing so may lead to withdrawal or a worsening of condition symptoms.
What is the most important information I should know about OCD medications?
Tell your physician about any medications, supplements, or substances you are currently taking before starting a new OCD medication.Never stop taking your medication suddenly; doing so may lead to withdrawal or a worsening of condition symptoms.
Obsessive-compulsive disorder(OCD) is commonly treated with both medication andcognitive 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 isselective 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.
FDA-Approved SSRIs for OCD
If you do not respond to SSRIs, your doctor may prescribe Anafranil (clomipramine). Anafranil is atricyclic antidepressantthat 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:
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.
Off-Label SNRIs for OCDResearch also shows twoserotonin-norepinephrine reuptake inhibitors(SNRIs), specifically Cymbalta (duloxetine) and Effexor (venlafaxine), to be just as effective as first-line medications.
Off-Label SNRIs for OCD
Research also shows twoserotonin-norepinephrine reuptake inhibitors(SNRIs), specifically Cymbalta (duloxetine) and Effexor (venlafaxine), to be just as effective as first-line medications.
Side Effects
Like all psychiatric medications, antidepressant OCD medications may cause side effects. Commonside effects of antidepressantsinclude:
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.
When to AugmentAugmentation therapyis usually only implemented if Anafranil or SSRIs fail to improve OCD symptoms after at least three months.
When to Augment
Augmentation therapyis usually only implemented if Anafranil or SSRIs fail to improve OCD symptoms after at least three months.
Antipsychotic OCD Medications
Two types ofantipsychotic medicationscan be used to treat OCD: first-generation and second-generation antipsychotics. Second-generation antipsychotics, also known asatypical antipsychotic medications, are usually chosen to augment SSRIs.
The following atypical antipsychotics have been found to work well:
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 causeextrapyramidal side effects(drug-induced movement disorders) in some people than the atypical antipsychotics.
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.
MedicationEffective Range (mg/day)Abilify15-30Risperdal1-2Seroquel150-600Zyprexa5-10Experts 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.When using an antipsychotic to augment OCD treatment, it’s a good idea to start with a lower dosage. At high doses, some atypical antipsychotics may worsen OCD symptoms.Side EffectsAntipsychotic medications also have the potential to cause side effects. Some of these include:ConstipationDizzinessDry mouthHigh cholesterolandblood sugar levelsJaundiceSedationUrinary retentionWeakened immune systemWeight gainAntipsychotic medications are associated with an increased risk fortardive dyskinesia, a movement disorder that causes uncontrollable movements. It also increases the risk of akathisia, which leads to restlessness and an inability to be still.Timeline and WithdrawalDon’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.Never stop taking an antipsychotic or change the amount you are taking without your physician’s approval, even if you feel better. Depending on which antipsychotic you’re taking, this can lead to unwanted effects and problems managing your illness.OCD Discussion GuideGet our printable guide to help you ask the right questions at your next doctor’s appointment.Download PDFSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.Early vs. Late-Onset OCD
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.
When using an antipsychotic to augment OCD treatment, it’s a good idea to start with a lower dosage. At high doses, some atypical antipsychotics may worsen OCD symptoms.
Antipsychotic medications also have the potential to cause side effects. Some of these include:
Antipsychotic medications are associated with an increased risk fortardive dyskinesia, a movement disorder that causes uncontrollable movements. It also increases the risk of akathisia, which leads to restlessness and an inability to be still.
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.
Never stop taking an antipsychotic or change the amount you are taking without your physician’s approval, even if you feel better. Depending on which antipsychotic you’re taking, this can lead to unwanted effects and problems managing your illness.
OCD Discussion GuideGet our printable guide to help you ask the right questions at your next doctor’s appointment.Download PDFSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide to help you ask the right questions at your next doctor’s appointment.
Download PDF
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Early vs. Late-Onset OCD
17 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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