Obsessive-compulsive disorder (OCD) is commonly treated with both medication and cognitive 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 Medications
The most commonly prescribed antidepressant medication used to treat OCD is selective serotonin reuptake inhibitors (SSRIs). Though they're traditionally used to treat depression, research has shown SSRIs to be the most effective medications for OCD, as well. In fact, SSRIs have been shown to help as many as 70% of people with OCD.
Four SSRIs are approved by the Food and Drug Administration (FDA) to treat OCD in adults:
- Luvox (fluvoxamine)
- Paxil (paroxetine)
- Prozac (fluoxetine)
- Zoloft (sertraline)
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.
Dosage
When treating OCD, SSRI doses are usually higher than those used for depression. Your doctor will probably start you on a low dose to begin with and increase it if needed.
The following listed dosages are according to American Psychiatric Association recommendations.
| Luvox | 50 | 200 | 300 |
| Paxil | 20 | 40–60 | 60 |
| Prozac | 20 | 40–60 | 80 |
| Zoloft | 50 | 200 | 200 |
Check your prescription and talk to your doctor to make sure you are taking the right dose for you. If after about 12 weeks your symptoms haven't decreased by about 40% to 50%, your doctor may either adjust your dosage or start you on a different SSRI.
Off-Label SSRIs and SNRIs
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, doctors often 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. Additionally, research also shows two serotonin-norepinephrine reuptake inhibitors (SNRIs), specifically Cymbalta (duloxetine) and Effexor (venlafaxine), to be just as effective as first-line medications.
Antipsychotic Augmentation
About 40% to 60% of people with OCD do not show satisfactory response to SSRIs alone. As a rule, "response" is defined as a 25% to 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 doctor 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 Augment
Augmentation therapy is usually only implemented if Anafranil or SSRIs fail to improve OCD symptoms after at least three months. Specifically, most treatment guidelines recommend that antipsychotics are tried if you fall into one of the following categories:
- Non-response: Less than 25% reduction in overall Y-BOCS
- Partial response: Greater than 25% but less than 35% reduction in Y-BOCS after adequate treatment with an SSRI
- Incomplete remission: Response to SSRI medications (greater than 35% reduction on the Y-BOCS), but have not achieved remission of symptoms
Antipsychotic Medications
Two types of antipsychotic medications can be used to treat OCD: first-generation and second-generation antipsychotics. Second-generation antipsychotics, also known as atypical antipsychotic medications, are usually chosen to augment SSRIs. The following atypical antipsychotics have been found to work well:
- Abilify (aripiprazole)
- Risperdal (risperidone)
- Seroquel (quetiapine)
- Zyprexa (olanzapine)
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 cause extrapyramidal side effects (drug-induced movement disorders) in some people than the atypical antipsychotics.
Dosage Information
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 than lower doses. Below are some typical dose ranges for antipsychotic augmentation although actual effective dosages can be different.
| Abilify | 15-30 |
| Risperdal | 1-2 |
| Seroquel | 150-600 |
| Zyprexa | 5-10 |
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 doctor 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. Studies have shown that, at high doses, atypical antipsychotics may worsen OCD symptoms.
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 doctor'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.
A Word From Verywell
As with any medical treatment, the decision to start a new medication or add a medication to your treatment strategy is a choice that should be made in strong collaboration with your family doctor or psychiatrist.
It's important to be honest and upfront about your symptoms so your doctor can develop the best plan for you. In addition, simply because a medication is prescribed doesn't mean that the communication between you and your mental health professional is over. If you experience side effects or notice changes in your mood when starting a new medication, it's important to let your doctor know.
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Additional Reading
Pizarro M, Fontenelle LF, Paravidino DC, Yücel M, Miguel EC, de Menezes GB. An updated review of antidepressants with marked serotonergic effects in obsessive-compulsive disorder. Expert Opin Pharmacother. 2014;15(10):1391-1401. doi:10.1517/14656566.2014.914493
By Owen Kelly, PhD
Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders.
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