OCD is often seen more as a peculiarity than as what it really is, a psychological disorder, and like all disorders, it involves intrusion into the life of the person who has it.

That is why people with this disorder must receive treatment, either in the form of psychotherapy or with psychopharmaceuticals, so that they can have a significant improvement in their quality of life.

In this article, we’ll look at the main medications for OCD , their adverse effects, their precautions, and the mechanisms that explain why they’re beneficial for people diagnosed with the disorder.

What is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder (OCD) is the fourth most common disorder, trailing only phobias, addictions, and depression. The first symptoms of this psychological problem appear as early as childhood, becoming more severe as the individual grows older. Among the most noteworthy behaviours of patients with this disorder are rituals, perfectionism and manias, behaviours which appear in times of special stress .

Although the severity of the disorder varies greatly, depending on the type of behaviour the patient displays, it usually involves a high degree of intrusion into his or her life. Despite this, few people seek professional help, and it is estimated that only 35% to 40% of those with OCD attend therapy of their own volition .

Because OCD is rooted in the personality aspects of the individual who has it, there is no such thing as a treatment that will ‘cure’ it completely. That’s why, in most cases, therapy is aimed at helping the patient gain control over his or her obsessions and compulsions, rather than eliminating them entirely. For this reason, patients with the disorder will, in most cases, have to go to therapy for life.

The two main routes of treatment for OCD, which have scientific evidence behind them, are psychotherapy, especially cognitive-behavioral therapy (CBT), and medication . Alternative treatments such as homeopathy, phytotherapy, meditation, exercise, or mindfulness currently lack adequate scientific evidence to demonstrate significant improvement in the patient’s life, although this does not mean that these latter treatments cannot be potentially therapeutic.

Medications for OCD

There are several medications for OCD, although their use varies depending on a person’s characteristics, the severity of his or her obsessions and compulsions, how effective previous treatments have been, and the occurrence of adverse effects.

Antidepressants

Usually, the first treatment option is the use of antidepressants. The name of this group of drugs may lead one to think, mistakenly, that they are only prescribed for depression, but the truth is that they contribute to a euthymic, i.e. non-pathological, state of mind . Since OCD is an anxiety disorder, and antidepressants are used for this type of disorder as well, it’s not surprising that they have uses for this particular disorder.

Antidepressants are drugs that help regulate, above all, the levels of serotonin , a neurotransmitter, in the synaptic cleft, preventing it from being reuptake and carried into the neuron.

Among the most specialized in this function we find the Selective Serotonin Reuptake Inhibitors, whose action falls exclusively on the reuptake of this neurotransmitter. Among these drugs are fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil, Pexeva), escitalopram (Lexapro), citalopram (Celexa) and sertraline (Zoloft).

For children diagnosed with OCD , the two antidepressant drugs usually prescribed are sertraline, for those over 6 years old, and fluvoxamine, for those over 8 years old.

Other antidepressants used for OCD are the Serotonin and Noradrenaline Reuptake Inhibitors , drugs that, in addition to acting on the mechanisms of serotonin collection, intervene in other neurotransmitters, in this case, noradrenaline. Among the drugs in this group we find venlafaxine and mirtazapine, and they are used when, once prescribed, the SSRIs have not been effective for the patient or, in addition to OCD, the patient also presents depression.

Also of note is a tricyclic antidepressant used for OCD: clomipramine (Anafranil).

Among the precautions of antidepressants, whether SSRIs or SNRIs , we find that they should not be prescribed to pregnant or nursing women, the elderly, or those with heart problems.

It should be noted that, although most antidepressants are safe, they run the risk of encouraging the emergence of suicidal thinking and autolytic attempts . It has been seen that children and adolescents who have been prescribed these drugs may have an increase in suicidal thinking, especially during the first weeks of treatment or when the dose of the medication has been modified. However, these adverse effects are temporary, with significant improvement in the long term.

Although antidepressants are not considered addictive, it is possible that some physical dependence on them may occur . This dependence is different from what is understood by addiction, but it does require that the interruption of treatment be done in a regulated manner, progressively reducing the doses rather than stopping the treatment altogether. If this is done, the person may show withdrawal symptoms, which is known as discontinuation syndrome.

Antipsychotics

Another group of drugs used to medically treat OCD are antipsychotics. These medications aren’t used separately, but rather in combination with SSRIs , because they improve their therapeutic effects, significantly reducing the symptoms of the disorder.

Among the most used are risperidone (Risperdal), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel) and aripiprazole (Abilify).

Other drugs

Research is currently underway on the use of several alternative drugs, especially those that intervene on the brain’s glutamatergic pathways. The most studied are memantine (Namenda), topiramate (Topamax) and riluzole (Rilutek) .

Bibliographic references:

  • Jenike MA. “Clinical Practice: Obsessive-Compulsive Disorder,” New England Journal of Medicine (Jan. 15, 2004): Vol. 350, No. 3, pp. 259 – 65.
  • Koran LM, et al. “Practice Guideline for the Treatment of Patients with Obsessive-Compulsive Disorder,” American Journal of Psychiatry (July 2007): Vol. 164, No. 7, Suppl.
  • Jefferson, J. W. and Greist, J. H. (1997). Pharmacological treatment in obsessive-compulsive disorder. Journal of Drug Addiction, 12. 12 – 21.
  • Asociación Americana de Psiquiatría (APA). (2013). Manual diagnóstico y estadístico de los trastornos mentales (5ª ed.). Arlington, VA: Publicación Psiquiátrica Americana.
  • Organización Mundial de la Salud (1992). Clasificación Internacional de Enfermedades y Problemas Relacionados con la Salud, Décima Revisión (ICD-10). Ginebra.
  • Colesa, M.E.; Frostb, R.O.; Heimberga, R.G.; Rhéaumec J. (2003). “No sólo experiencias correctas”: perfeccionismo, rasgos obsesivo-compulsivos y psicopatología general. Behaviour Research and Therapy 41 (6): págs. 681 a 700.