Medications that Treat OCD and OC Spectrum Disorders

by Richard S. Schloss, M.D.

I am often asked, "Dr. Schloss, what is the best medication to treat OCD?" The answer is that there is no one medication that is effective in treating OCD for every patient. While there are a number of medications that produce significant improvement in OCD symptoms in many patients, I am used to seeing patients who have little or no response to the first medication prescribed for them, but who then go on to enjoy excellent results from the second. Often patients have only a limited or partial response to a single drug, and require a combination of agents to achieve a good response.

In the United States, the Food and Drug Administration has approved five medications specifically for the treatment of Obsessive Compulsive Disorder. They are: Anafranil (clomipramine), Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), and Luvox (fluvoxamine). With the exception of Anafranil, all belong to a class of antidepressant drugs called Selective Serotonin Reuptake Inhibitors, or SSRIs. (Anafranil belongs to an older class of drugs called Tricyclic Antidepressants.) Celexa (citalopram), and its more refined version, Lexapro (escitalopram), are newer SSRIs available in the U.S. that also appear very helpful for OCD, but they do not yet have specific approval from the FDA for the treatment of OCD. Other antidepressants that have been used with reported success in treating OCD and OC Spectrum Disorders include Effexor (venlafaxine) and Serzone (nefazodone).

Medications used to enhance the efficacy of SSRIs or Anafranil in reducing OCD symptoms (often referred to as "augmentation") include: BuSpar (buspirone), Remeron (mirtazapine), Klonopin (clonazepam), Risperdal (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine), Geodon (ziprasidone), Abilify (aripiprazole), Depakote (divalproex), Neurontin (gabapentin), Lamictal (lamotrigine), Topamax (topiramate), Gabatril (topiramate), and Lithium Carbonate. In addition, Inositol, a B-vitamin available without prescription from most health-food stores and many pharmacies, has shown effectiveness in reducing OCD symptoms when taken with SSRIs, and, in some cases, even when taken alone (although dosages had to be pushed to fairly high levels).

No matter which medication is prescribed, doctor and patient must always be willing to satisfy "The Two D's." By this I mean DOSE and DURATION -- that is, one must ultimately take a large enough dose to allow for therapeutic efficacy (even if you start low to minimize initial side effects); and, one must stick with the full therapeutic dose long enough to permit the adjustments in brain chemistry necessary for symptom reduction to take place. As we have learned more about pharmacotherapy of OCD, it has become apparent that the old rule of "two to four weeks" applied to treatment of depression is totally inadequate in most cases of OCD. Rather, it is not unusual to see lag times of eight, ten, or even twelve weeks on a medication before OCD symptoms begin to recede. The doctor who repeatedly changes medication every couple of weeks in his impatience to see results is actually doing his patient a grerat disservice. By the same token, the patient who gives up after only a few weeks of drug treatment is cheating himself. When you think of how long the average patient suffers with OCD before being properly diagnosed and treated (ten years, by most accounts), waiting three months for your medication to work doesn't seem like such a huge investment of time.