Medication Management (Psychiatry)

If OCD is in the moderate to severe range, medication can often be helpful. Medications for OCD work by having an effect on the neurotransmitter, serotonin. A neurotransmitter is a chemical that helps communicate messages between brain cells. These medications are called selective serotonin reuptake inhibitors (SSRIs) and they work by allowing more serotonin to be present in certain parts of the brain. The main SSRIs used to treat OCD are Fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft). Each of these medications have have been approved by the U.S. Food and Drug Administration for the treatment of OCD. All of these SSRIs appear to be equally effective.

Citalopram (Celexa) and escitalopram (Lexapro) are also often used. Clomipramine (Anafranil) is a tricyclic antidepressant that is sometimes used to treat OCD but it often has more severe negative side effects. Because of this, SSRI’s are often the first medication that a psychiatrist will try.

Dosages for SSRI’s used to treat OCD are often higher than for other disorders. This is why it is important to receive medication from a psychiatrist who is well-versed in the treatment of OCD. Usually, dosages are increased over four to six weeks until a proper dosage is reached. In some cases, psychiatrists will use dosages that are significantly higher. If this is the case, your psychiatrist will closely watch you for possible negative side effects. It usually takes at least 4-6 weeks to notice any improvement in symptoms. For some, it may take 10 to 12 weeks or longer. Relapse in OCD is common within the first 24-52 weeks of treatment. Because of this, patients are encouraged to continue medications for at least 12 months. A trial of at least two, and sometimes three, SSRIs should be considered before switching to a different class of medication like clomipramine. SSRI’s are normally recommended indefinitely since relapse is high when medication is the only treatment.

On average, people with OCD experience only a 30% reduction in symptoms when they use SSRI’s as their only treatment. This symptom reduction is normally higher when combined with Exposure and Response Prevention (ERP) therapy.

Dr. Joshua Riley-Graham is an expert in the psychiatric management of OCD and related anxiety disorders. He works collaboratively with his patients so that the right type and dosage of medication can be achieved.

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