The Best Medication For OCD

Over the years mental health medication has become more sophisticated — along with our knowledge of what works best. When it comes to obsessive-compulsive disorder (OCD) it's a perfect example of how medication and psychology have evolved to better treat mental health disorders.

Examples of OCD can be seen all the way back to the 15th Century, when obsessive thoughts were thought to be brought on by the devil and treated by way of exorcism.

By the 1800s, OCD behavior had a medical explanation rather than a religious one, and although that was a big leap, treatment options were still limited. 

Fast forward to the 1950s, and psychologists began treating OCD with psychotherapy and behavioral therapy, providing some relief. 

Until finally, in the 1970s, more effective options began to arise. 

Nowadays, science’s understanding of OCD continues to evolve, and more effective treatment exists. Presently, a combination of therapy and medication is widely accepted as the best means of treating OCD. 

Learn more about where mental health professionals stand today when it comes to the best medications for OCD. 

Obsessive-compulsive disorder is characterized by unwanted (or intrusive) thoughts, causing anxiety and distress, and then developing into compulsive behaviors in response to these thoughts/anxieties. 

If you have OCD, you’ll often experience the same type of unwanted thought and then form patterns based on it. This could include thoughts like contamination, harm, sexual shame or others. 

Ultimately, these thoughts and behaviors start to become disruptive and lower your quality of life. 

We’ve talked more specifically about this in our article, Anxiety Disorders: An Overview.

In most cases, the first-line treatment of OCD is medication and therapy. 

More specifically, some types of antidepressant medications in combination with behavioral therapy like cognitive behavioral therapy or response prevention therapy. 

Medication and therapy combined have been found to be particularly effective. 

However, some folks may choose to treat OCD with just therapy or just medication alone. A mental health care professional can work with you to determine the best treatment plan based on your diagnosis and needs. 

The most common type of medication to treat OCD are antidepressants. Antidepressants work by changing the ways your brain pathways function to enhance levels of serotonin. Serotonin is thought to influence your mood, sleep and overall day-to-day function. 

For OCD particularly, selective serotonin reuptake inhibitors (SSRIs) are thought to be the best treatment option given their response rate and long-term results. Other options also include tricyclic antidepressants, although, for many, these cause more side effects. 

Here are some of the many SSRIs that have been found to be particularly helpful when it comes to OCD treatment. 

Paroxetine

Paroxetine specifically can help reduce anxiety and improve phobia symptoms. It has been found to be effective in multiple studies for OCD and is considered by many the first option when it comes to medication treatment. 

Fluvoxamine

Fluvoxamine also has consistent results across studies for helping treat OCD. Specifically, it has been found to help with social anxiety, avoidance and phobia symptoms after about two months of treatment. 

Escitalopram

Escitalopram is considered the most “selective” of the selective serotonin reuptake inhibitors,  meaning it is the best at just targeting serotonin and nothing else. It has little interaction with other bodily functions, which makes it a good antidepressant option when it comes to tolerability. Escitalopram has been shown to be both effective and tolerable in many studies.

While escitalopram hasn’t been approved by the FDA to specifically treat OCD, it is often prescribed off-label. 

Fluoxetine

Fluoxetine effects on OCD specifically have shown improvements in symptoms like obsessive thoughts, excessive washing, and phobia symptoms. Researchers have also found that fluoxetine can be an effective short-term and medium-term treatment of phobia symptoms. 

Sertraline

Sertraline has been found to be effective in treating phobia states and reducing some of the fear symptoms. There is also research that shows sertraline in combination with therapy is a good long-term option to improve obsessive symptoms. 

A different category of antidepressants are tricyclic antidepressants (TCAs). TCAs, and specifically clomipramine, were actually the first drugs used to treat OCD, and are still an effective medication treatment. However, because it tends to have more common side effects for people, SSRIs have become more popular. 

Clomipramine 

Clomipramine functions really similarly to SSRIs as far as how it influences serotonin. Clomipramine has been shown in multiple studies to be effective in reducing OCD symptoms. Some of which show clomipramine outperforms other treatments like therapy, and the medication alone is just as effective as therapy. 

However, clomipramine also has potential side effects, sometimes being more serious ones like seizures and liver damage. 

In addition to antidepressants, some with OCD may add on additional drugs. This typically occurs if antidepressants alone aren’t working. In that case, other medications like antipsychotics may be added. 

Antipsychotics like haloperidol, risperidone and aripiprazole have all shown positive effects as an addition to OCD treatment. 

However, other antipsychotics are less promising.

Ultimately, the treatment you decide for OCD will be up to you and your mental health care provider. There are many options depending on what you’re looking for in treatment, your personal preferences and types of medication that work best to treat your symptoms. 

Medications like antidepressants have been found to be the most effective medication option for OCD. However, the specific antidepressant will depend on what kind works best for your body. Talk with a mental health professional to determine what’s best.

Once you’re on the medication, stay in touch with your provider to determine whether or not any side effects present themselves and whether you should continue with treatment or switch to a different kind.