From the Guidelines
SSRIs are the primary medications used to treat Obsessive-Compulsive Disorder (OCD) and anxiety.
Medication Options
- SSRIs: The first-line pharmacological treatment for OCD, with higher doses often used compared to other anxiety disorders or major depression 1.
- Clomipramine: A non-selective SRI that was the first agent to show efficacy in OCD, but has a lower safety and tolerability profile compared to SSRIs 1.
Key Considerations
- Dosing: Higher doses of SSRIs are associated with greater treatment efficacy, but also higher rates of dropout due to adverse effects 1.
- Adverse Effects: A careful assessment of SSRI adverse effects is crucial when establishing the best dose for each patient 1.
- Individualization: Genetic variation, such as cytochrome P450 2D6 (CYP2D6) and cytochrome P450 2C19 (CYP2C19), may contribute to differential risk and benefit ratios, and pharmacogenetic guidelines can help individualize treatment selection 1.
Specific Medications
- Fluoxetine: FDA approved for OCD, major depressive disorder, and other conditions, with a black box warning for treatment-emergent suicidality in adolescents and young adults 1.
- Paroxetine: FDA approved for OCD, major depressive disorder, and other conditions, with a black box warning for treatment-emergent suicidality in adolescents and young adults 1.
From the Research
Medications for Obsessive-Compulsive Disorder (OCD) and Anxiety
- Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy treatments for OCD 2, 3, 4, 5
- Clomipramine is effective in OCD but associated with more adverse events 2, 3, 4, 6
- Tricyclic antidepressants (TCAs) are equally effective as SSRIs, but are less well tolerated 2, 3
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) are recommended for anxiety disorders 2, 3
- Pregabalin is a first-line treatment for anxiety disorders 2
- Benzodiazepines may be used in treatment-resistant cases of anxiety disorders, but only in patients with no history of dependency and tolerance 2, 3, 6
- Atypical antipsychotics, such as quetiapine, may be used as augmentation therapy for OCD and anxiety disorders 2, 3
- Irreversible and reversible monoamine oxidase inhibitors may be used as alternative treatments for OCD and anxiety disorders 2, 3, 5
Treatment Strategies
- Cognitive-behavioral therapy (CBT) is recommended alone or in combination with medications for OCD and anxiety disorders 2, 3, 4, 5
- Augmentation of antidepressants with atypical antipsychotics or other medications may be effective for nonresponders 2, 3, 4
- Switching to other medications or using brain stimulation techniques may be considered for refractory cases 4, 5