Medications can help lessen the intensity of symptoms of OCD by keeping neurotransmitter levels consistent.

Medications often come with potential side effects, and sometimes the list of what “could” happen feels more intimidating than what you’re already experiencing.

It’s natural to be apprehensive when starting a medication.

But for the majority of people living with OCD, medication can help reduce symptoms and improve quality of life.

Obsessive-compulsive disorder is a mental health condition defined by uncontrollable obsessions, compulsions, or both.

Obsessions can be thoughts, images, or urges that repeat continuously and feel like they’re beyond your control. They’re often unwelcome and intrusive, and they can come with a number of negative emotions, such as fear, anger, or self-doubt.

Compulsions are also repetitive thoughts or behaviors, but the purpose of a compulsion is to neutralize the obsession.

Obsessions and compulsions can impact your day-to-day functioning in important areas of your life, such as school, work, or relationships.

Medications can be used to help manage the obsession-compulsion processes in the brain.

The majority of prescriptions for this purpose belong to a class of medications called selective serotonin reuptake inhibitors (SSRIs), though other serotonin-targeting medications can be used, including:

  • serotonin reuptake inhibitors (SRIs)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)

Some of the most common medications for OCD include:

Anafranil is the most researched and longest-used OCD medication, according to the International OCD Foundation (IOCDF).

Of the five medications approved by the Food and Drug Administration (FDA) to treat OCD, Anafranil is the only SRI, though it’s more commonly referred to as a tricyclic antidepressant (TCA).

The four SSRIs approved by the FDA include:

  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluvoxamine (Luvox)
  • fluoxetine (Prozac)

Medications that are sometimes prescribed but not FDA approved for treating OCD include:

  • venlafaxine (Effexor)
  • duloxetine (Cymbalta)
  • escitalopram (Lexapro)
  • citalopram (Celexa)

These medications are considered “off-label” when they’re prescribed for OCD, meaning they’re not yet approved by the FDA for treating this condition but still may be effective for it.

Most medications come with a recommended dosing protocol. A healthcare or mental health professional may adjust your individual dose based on your needs, symptom improvement, and tolerance levels.

Standard dosages in milligrams per day (mg/day) for OCD medications may include:

  • venlafaxine (Effexor): up to 375 mg/day
  • duloxetine (Cymbalta): up to 120 mg/day
  • clomipramine (Anafranil): up to 250 mg/day
  • escitalopram (Lexapro): up to 40 mg/day
  • citalopram (Celexa): up to 40 mg/day
  • sertraline (Zoloft): up to 200 mg/day
  • paroxetine (Paxil): 40 to 60 mg/day
  • fluvoxamine (Luvox): up to 300 mg/day
  • fluoxetine (Prozac): 40 to 80 mg/day

Many OCD medications are traditionally known as antidepressants, but they can also help ease symptoms of OCD.

The exact cause of OCD remains under investigation, but experts suggest that imbalances in the neurotransmitter serotonin may play a role in the obsession symptoms of OCD.

A 2015 study found that low levels of serotonin may contribute to obsessions.

SRIs, SNRIs, and SSRIs work by blocking the reabsorption of serotonin into neurons (nerve cells), which means the amount of available serotonin increases.

Most prescription medications come with a list of possible side effects.

Common side effects of antidepressant medications include:

  • sexual dysfunction
  • headaches
  • appetite changes
  • dizziness
  • diarrhea or constipation
  • nausea
  • feeling of agitation
  • anxiety
  • sleep disturbance
  • weight changes
  • sweating
  • dry mouth
  • vision changes
  • increased heart rate

A 2020 cohort study suggests that long-term use of antidepressants may increase your chance of type 2 diabetes. But more research is needed.

Other less common but potentially serious side effects may include:

You may experience some side effects when you first start a medication, but these are generally temporary. It can take time for your body to adjust to a new medication.

If your side effects last for several weeks without improvement or if you’re concerned, consider reaching out to your doctor immediately. Your doctor will work with you to assess what’s happening and make any adjustments as needed.

Not everyone can take antidepressants.

If you’re pregnant or planning to become pregnant, talk with your doctor about any potential challenges with taking an antidepressant.

Prozac, Luvox, and Zoloft have been FDA-approved for use in children over the age of 8. But some antidepressants may not be appropriate for all children.

Antidepressants may not be recommended if you live with conditions such as:

Antidepressants may not be recommended or dose adjustments may be needed if you:

  • take other serotonin-increasing medications
  • operate heavy machinery (as drowsiness or vision changes can interfere with this)
  • consume alcohol
  • take herbal supplements such as St. John’s wort

SSRIs and other traditional OCD medications work for approximately half of the people taking them, according to a 2010 review of studies.

When antidepressants aren’t making enough impact, supplemental therapy with antipsychotics or other classes of medication may be recommended.

Taking an antipsychotic does not mean that you’ve been losing touch with reality.

Antipsychotics influence the neurotransmitter dopamine in your brain. Like serotonin, dopamine is emerging as an important neurotransmitter involved in OCD symptoms, according to a 2020 review. However, more research is needed.

Common antipsychotics that may be used include:

When should I take this medication?

OCD medications are intended to be used on a regular schedule, not just when you’re experiencing symptoms.

These medications work by keeping serotonin at a consistent level. Taking them as consistently as possible is often an important factor in their success.

Your doctor will help determine the dose and frequency that’s right for you and your symptoms.

If you miss a dose, they will advise you on what to do.

Doubling up on medication or skipping multiple doses without guidance from a doctor may cause symptoms to return or worsen, and it may increase the likelihood of experiencing negative side effects.

What if I have an obsessive fear of medications?

Living with OCD may mean having an obsession that revolves around taking medications.

If this is the case, therapy may be the first step to help you overcome your fear of medication.

Exposure response prevention (ERP) therapy, a form of cognitive behavioral therapy (CBT), is considered a first-line treatment option for OCD.

ERP involves gradual exposure to things in your environment related to your obsessions.

With the guidance of a mental health professional, you can learn new ways of coping with the stress that leads to obsessions without the creation of compulsions.

How long will I have to take medication?

There’s no definitive timeline for how long you may need to take OCD medications.

Medication is recommended for a period of at least 3 months, according to research from 2010. It generally takes about that amount of time to see a reduction in symptoms and determine if that type of medication and dosage will be helpful for your symptoms.

If an improvement in your symptoms is noted, you’ll continue with a maintenance dose. A maintenance dose is a dose you regularly take to maintain the levels and effects of the medication.

Medications are typically continued for 1 to 2 years before gradually reducing the dose, aka tapering off. If you experience a recurrence of symptoms, you may have to use the medication for an unspecified or unlimited amount of time.

What if I can’t afford my medication?

The cost of medication is a concern for many people.

Consider asking your doctor about free samples. These can be offered for a short time if you can’t afford a prescription.

If cost remains a challenge, you may find help through state prescription programs available at your local pharmacy.

To learn more about the assistance options available, you can check out the medicine assistance tool online or call 888-477-2669.

The federal government also offers prescription assistance programs. You can learn more about them by visiting the Centers for Medicare & Medicaid Services (CMS).

If you or someone you know is living with OCD, there is support available.

The IOCDF offers a list of support groups near you. You can also check out the IOCDF’s list of online or telephone support groups for help. Other resources offered by the IOCDF include:

If you want to know more about what resources are available, you can check out our OCD resource directory.

While they do come with potential side effects, medications can help improve symptoms of OCD for many people.

A healthcare or mental health professional can work with you to decide which medications are right for you and your symptoms.

SSRIs, SNRIs, and SRIs are the most common classes of medications used to treat symptoms of OCD.

If your symptoms aren’t improving or seem resistant to first-line approaches, your treatment may be supplemented with other medications, such as antipsychotics.

OCD medications are almost always recommended in combination with psychotherapy approaches such as ERP.