In previous posts, I’ve written about how cognitive behavioral treatment (specifically, CBT with exposure and response prevention) has been shown to be much more effective in treating obsessive compulsive disorder (OCD) than medication. Nevertheless, many people with OCD are still interested in seeing if they can find a medication that will turn down the intensity of the anxiety. I’ve found that this can sometimes be helpful and may allow the person to more fully participate in CBT.
Clients regularly ask me for medication recommendations. Because I am not a medication prescriber, I avoid suggesting particular medications or dosages but will talk to them about the pros and cons of trying medication. I recently deepened my knowledge of the pros and cons of medications for OCD when I attended a training though the International OCD Foundation. At this workshop, Dr. Michele Pato, a psychiatrist at the University of Southern California, discussed the use of medications for OCD. Here’s a chart with her suggestions for medications:
Based on Dr. Pato’s advice, here are a few things to consider in choosing a medication:
- It’s common to start with a class of antidepressants known as Selective Serotonin Reuptake Inhibitors (SSRI’s). Dr. Pato mentioned she typically starts with Sertraline (known as Zoloft commercially).
- The dose needed for OCD is typically higher than the dose used for depression.
- If SSRI’s aren’t effective, there’s also evidence that an older Antidepressant called Clomipramine may work. However, it is important to be cautious when taking Clomipramine because—unlike the SSRI’s—it can kill someone when the dosage is too high. Additionally, Clomipramine can interact badly with another SSRI Fluoxetine (Prozac), making it toxic even in smaller doses.
- Side effects are common with taking antidepressants, but the side effects often fade over time.
- With OCD, it may take 8-12 weeks before there’s any noticeable improvement, so it’s usually a good idea to give the medication enough time to be effective.
- There’s a high risk that OCD symptoms will increase when stopping an antidepressant medication, but this risk can be reduced if the individual has had a successful course of CBT + ERP. Dr. Pato mentioned that she frequently tapers people off medication after they successfully complete treatment.
Please note: As I mentioned, I am not a prescriber and am passing on information I learned from a reputable source. As many people with OCD do not have access to a specialist in pharmacology for OCD and often turn to a general practitioner, I offer this is a guide that may be of some use.
Author: Brian Thompson Ph.D.
Brian is a licensed psychologist and Director of the Portland Psychotherapy Anxiety Clinic. His specialties include generalized anxiety, OCD, hair pulling, and skin picking.