Obsessive Compulsive Disorder medications & treatments
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Obsessive-Compulsive Disorder (OCD) is a chronic mental disorder characterized by uncontrollable, reoccurring thoughts (obsessions) that make people feel driven to do something repetitively (compulsions). It is estimated that it affects about 1 in 100 adults (2-3 million) and 1 in 200 kids and teens (500,000) in the U.S. This equals about 2 to 3 percent of Americans with this condition, according to the American Psychiatric Association. OCD can start at any age but it typically first appears in adolescents between the ages of 8 to 12 or between the late teen years and early adulthood. Women are 1.6 times more likely to experience OCD than men.
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental illness where you have unwanted thoughts and fears (obsessions) that make you feel driven to do repetitive behaviors (compulsions). These obsessions and compulsions can interfere with your daily life. Many people with OCD know their obsessions are not realistic but if they don’t perform the repetitive behaviors, it can cause them significant distress.
Researchers think that OCD involves communication problems between the front part of the brain and deeper structures of the brain.
Other risk factors that can increase your risk of developing OCD include:
- Trauma. Stressful or traumatic events, especially in your childhood, can increase your risk of OCD or worsen your existing symptoms.
- Genetics. If you have a family member with OCD, you are also more likely to develop OCD.
- Other related disorders. OCD often occurs with other mental health conditions such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, Tourette’s syndrome, and depression.
- PANDAS. OCD can occur suddenly in children following a streptococcal infection. This syndrome is called pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS).
- Brain injury. OCD symptoms can sometimes develop after a traumatic head injury.
How is OCD diagnosed?
There is no test your healthcare professional can use to diagnose OCD. A diagnosis is typically given based on your symptoms. It can be hard to correctly diagnose OCD because its symptoms are shared by other mental disorders such as body dysmorphic disorder, anxiety disorder, eating disorders, and hoarding disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), OCD is diagnosed based on the following:
- You have obsessions, compulsions, or both.
- The obsessions/compulsions are time-consuming (more than 1 hour per day).
- The obsessions/compulsions cause significant distress
- The obsessions/compulsions impair work or social functioning
- The symptoms aren’t caused by substance abuse, medications, or another mental disorder
Symptoms of OCD can include obsessions, compulsions, or both.
Obsessions are recurrent intrusive thoughts, urges, or images that can cause emotional distress. Common obsessions include:
- Fear of contamination or germs
- Unwanted or disturbing sexual thoughts
- Fear of blurting out obscenities or acting inappropriately in public
- Thoughts about harming others or yourself
- Stress if things are in perfect order or facing a certain way
Compulsions are the repetitive behaviors you are driven to do with OCD in response to your obsessive thoughts. These behaviors or rituals are used to help control your anxiety from the obsession. Common compulsions can include:
- Excessive or repeated hand washing
- Excessive showering, brushing your teeth, or grooming
- Cleaning household items or other objects repeatedly
- Checking locks, light switches, or appliances repeatedly
- Counting while performing a task to end on the “right” number
- Arranging items in a specific way
- Praying to prevent harm to yourself or others
- Repeating routine activities such as going in and out of doors
What are some OCD treatment options?
Patients with OCD who receive appropriate treatment commonly experience an increased improved quality of life and improved functioning. The most effective treatments for OCD include cognitive-behavioral therapy and medications.
- Selective serotonin reuptake inhibitors (SSRIs). These antidepressants are typically the initial treatment for OCD. They work by increasing the amount of serotonin in your brain to help control your OCD symptoms. It can take 2 to 3 months before you see the full effect of these medications. Examples include Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine).
- Tricyclic antidepressants (TCAs). These older antidepressants, including Anafranil (clomipramine), are typically used if you have failed other options.
- Antipsychotics. If you still have symptoms with an SSRI, your doctor may prescribe an antipsychotic such as Abilify (aripiprazole) or Risperdal (risperidone) to enhance their effects.
- Selective norepinephrine reuptake inhibitors (SNRIs). Medications such as Effexor XR (venlafaxine) and Cymbalta (duloxetine) are used off-label to treat OCD.
Cognitive-behavioral therapy (CBT) is the most popular and effective type of psychotherapy used to treat OCD. One form of CBT, known as exposure and response prevention (ERP), involves exposing you to situations that typically trigger compulsions such as touching a dirty object. Instead of responding with your usual ritual, you will learn other ways to cope with these triggers. ERP therapy is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SSRI medications.
- Deep brain stimulation (DBS). This FDA-approved treatment uses electrodes to send electrical impulses to certain areas of the brain that are thought to control OCD behaviors. It is used in cases that have not responded to other therapies.
- Transcranial magnetic stimulation (TMS). TMS uses a magnetic pulse to stimulate nerve cells in your brain which can help with OCD symptoms. This FDA-approved treatment is also used when other therapies have failed.
What is the best medication for OCD?
The best medication for the treatment of OCD will depend on the individual’s specific medical OCD, medical history, medications and supplements that the individual is already taking that may potentially interact with OCD medications, and the individual’s potential response to the treatment. It is advisable to always speak with your doctor or mental health professional about the best medication for you. The table below includes a list of the most prescribed or over-the-counter OCD medications approved by the Food and Drug Administration (FDA).
Best medications for OCD
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Prozac (fluoxetine)||SSRI||Oral||20mg to 60mg once daily.||Insomnia, nausea, headache, weakness, diarrhea, loss of appetite|
|Celexa (citalopram)||SSRI||Oral||20mg to 60mg once daily.||Dry mouth, nausea, drowsiness, insomnia, increased sweating|
|Lexapro (escitalopram)||SSRI||Oral||10mg to 20mg once daily.||Headache, nausea, insomnia, diarrhea, drowsiness|
|Luvox (fluvoxamine)||SSRI||Oral||100mg to 300mg divided every 12 hours.||Nausea, headache, drowsiness, weakness, insomnia, diarrhea, dry mouth|
|Paxil (paroxetine)||SSRI||Oral||10mg to 60mg once daily.||Nausea, insomnia, dry mouth, headache, weakness, diarrhea|
|Zoloft (sertraline)||SSRI||Oral||50mg to 200mg once daily.||Nausea, diarrhea, insomnia, dry mouth, drowsiness, dizziness|
|Effexor XR (venlafaxine)||SNRI||Oral||37.5mg to 225mg once daily.||Headache, nausea, insomnia, weakness, dizziness, ejaculation disorder|
|Cymbalta (duloxetine)||SNRI||Oral||20mg to 60mg once daily.||Nausea, dry mouth, headache, drowsiness, fatigue|
|Anafranil (clomipramine)||TCA||Oral||100mg to 250mg daily divided with meals.||Dry mouth, headache, constipation, fatigue, weight gain, sexual dysfunction|
|Abilify (aripiprazole)||Antipsychotic||Oral||10mg to 30mg once daily.||Weight gain, headache, agitation, insomnia, anxiety, nausea|
|Risperdal (risperidone)||Antipsychotic||Oral||1mg to 6mg once daily.||Drowsiness, insomnia, anxiety, agitation|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical OCD, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of OCD medications?
As with all medicines, those used for OCD will have some side effects, depending on the class of medication you are taking. The most common side effects of medications used to treat the obsessive-compulsive disorder include:
- Dry mouth
- Sexual dysfunction
What are some home remedies for OCD?
While medications and cognitive therapy are the first-line treatment for OCD, there are some lifestyle changes and self-care management strategies you can use to help reduce your symptoms and maintain your quality of life
- Relaxation techniques. Stress is a major trigger for patients with OCD, so use relaxation techniques such as mindful meditation, yoga, deep breathing, and massage to help lower your stress and help manage your urges.
- Get enough sleep. Creating a sleep routine can help lower levels of your stress hormones and help improve your mood.
- Get regular exercise. Exercise is a natural way to reduce anxiety and help control your OCD symptoms.
- Find a support group. It is important to have a strong support system if you have OCD. Just talking about your urges or your fears can make them feel less real and less threatening. Find an understanding friend, family member, or support group that you can share your feelings with.
- Avoid alcohol and nicotine. While alcohol may seem to ease your stress, it will cause even more as it wears off. Nicotine is a stimulant that can increase your anxiety as well.
Frequently asked questions about OCD
What’s the difference between obsessions and compulsions?
Obsessions are persistent and repeated thoughts, images, or impulses that trigger distressing feelings. Compulsions are repetitive behaviors that are performed to try and get rid of these feelings of distress.
How common is OCD?
It is estimated that it affects about 2 to 3 percent of Americans. This is approximately 1 in 100 adults (2-3 million) and 1 in 200 kids and teens (500,000) in the United States.
Is there a cure for OCD?
There is no cure for OCD but treatments such as medications, cognitive therapy, and self-care management can help reduce your symptoms.
What happens if severe OCD is left untreated?
OCD can lead to other severe mental health conditions, such as anxiety and panic attacks, depression, and substance abuse if left untreated.
Related resources for OCD
- OCD overview. MayoClinic
- About OCD. International OCD Foundation
- What is OCD? Psychiatry.org
- OCD signs and symptoms. National Institute of Mental Health
- OCD symptoms and treatment. Cleveland Clinic