From the Guidelines
Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication treatment for Obsessive-Compulsive Disorder (OCD). According to the most recent evidence 1, SSRIs have been shown to be effective in reducing OCD symptoms, with higher doses associated with greater treatment efficacy. The recommended duration of an SSRI trial is 8-12 weeks to determine efficacy 1.
Medication Options
Some commonly prescribed SSRIs for OCD include:
- Fluoxetine (20-80 mg daily)
- Sertraline (50-200 mg daily)
- Fluvoxamine (100-300 mg daily)
- Paroxetine (20-60 mg daily)
- Escitalopram (10-40 mg daily)
These medications typically require higher doses for OCD than for depression and should be continued for at least 10-12 weeks to evaluate effectiveness, with treatment generally maintained for 1-2 years after symptom improvement 1.
Augmentation Strategies
If SSRIs are ineffective, clomipramine (a tricyclic antidepressant, 150-250 mg daily) may be tried, though it has more side effects 1. For partial responders to SSRIs, augmentation strategies include adding antipsychotics like risperidone (0.5-2 mg daily) or aripiprazole (2.5-15 mg daily) 1.
Treatment Algorithm
The treatment algorithm for OCD involves starting with SSRIs or cognitive-behavioral therapy (CBT), and then augmenting with other treatment modalities if necessary 1. Neurosurgery is only considered in highly refractory and severe cases.
Important Considerations
Patients should be aware that medication effects are gradual, taking 4-6 weeks for initial improvement, and should be combined with cognitive-behavioral therapy for optimal results. Side effects vary by medication but commonly include nausea, headache, sleep disturbances, and sexual dysfunction. A careful assessment of SSRI adverse effects is crucial when establishing the best dose for each patient 1.
From the FDA Drug Label
Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of obsessions and compulsions in patients with obsessive-compulsive disorder (OCD), as defined in the DSM-III-R; i.e., the obsessions or compulsions cause marked distress, are time-consuming, or significantly interfere with social or occupational functioning. Prozac is indicated for the treatment of obsessions and compulsions in patients with obsessive compulsive disorder (OCD), as defined in the DSM–III–R; i.e., the obsessions or compulsions cause marked distress, are time–consuming, or significantly interfere with social or occupational functioning. Clomipramine hydrochloride capsules, USP are indicated for the treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD).
The medications that can be given to a patient with Obsessive-Compulsive Disorder (OCD) are:
From the Research
Medication Options for OCD
The following medications can be considered for the treatment of Obsessive-Compulsive Disorder (OCD):
- Selective serotonin reuptake inhibitors (SSRIs) as first-line pharmacotherapy treatments 5
- Clomipramine, which is effective but associated with more adverse events 5, 6, 7
- Tricyclic antidepressants, which are equally effective as SSRIs but less well tolerated 5
- Serotonin norepinephrine reuptake inhibitors and pregabalin as first-line treatments for anxiety disorders, which often co-occur with OCD 5
- Atypical antipsychotics, such as quetiapine, as an augmentation strategy for non-responders 5, 8
- Benzodiazepines, in treatment-resistant cases, when the patient does not have a history of dependency and tolerance 5
Dosage Considerations
- The optimal dose of serotonin reuptake inhibitors (SRIs) for OCD is around 40mg fluoxetine equivalent, considering both efficacy and tolerability 9
- Higher doses of antidepressants are typically required for OCD, but may increase the risk of adverse events 5, 9
- Combination therapy with clomipramine and SSRIs may be effective in children and adolescents with OCD, but requires careful monitoring of side effects and drug interactions 6