(This information is NOT medical advice. It is for informational purposes only. Speak with your primary care provider or psychiatrist about medications.)
The majority of people with Obsessive Compulsive Disorder (OCD) respond to an SSRI (Selective Serotonin Reuptake Inhibitor) medication for their symptoms. At this point in time, the SSRI class of medications is the first-line psychotropic intervention for OCD –meaning, SSRIs help OCD symptoms most thoroughly.
However, approximately 15% of people with OCD do not respond to SSRI medications, or their symptoms show a low response. In these cases, prescribers may add a medication to ‘boost’ the effectiveness of the SSRI, treat the OCD symptoms in a different way, or treat the symptoms briefly.
If the SSRI medication (at a high dose) helps the OCD symptoms, but only partially, the prescriber may add a small dose of clomipramine (Anafrinil). This is a tricyclic medication, and was the primary med for OCD before SSRIs were created. Clomipramine acts on serotonin, but in a different way than SSRIs. Additionally, clomipramine may be prescribed as the sole medication to treat a person’s OCD symptoms if they have no response to an SSRI.
Other antidepressants, such as SNRIs (Serotonin Norepinephrine Reuptake Inhibitors), could be helpful for anxiety, but not typically, though it depends on the person’s biology. Other than SSRIs, some progressive psychiatrists may use glutamate blockers, such as memantine (Namenda) or riluzole (Rilutek). The remaining medications mentioned here may help OCD and other anxiety symptoms, but do not remedy the core issue –serotonin problems.
Anxiolytics, blood pressure meds, and antipsychotics round out the list of medications that can help reduce anxiety/OCD symptoms. First, benzodiazepines do a very good job in helping reduce anxiety for about 4-6 hours, depending on each mediation’s half-life. You may have heard of many of the meds in this benzodiazepine class, such as: lorazepam (Ativan); alprazolam (Xanax); clonazepam (Klonopin); and diazepam (Valium). When it is not possible to prescribe a benzodiazepine medication, some providers utilize a medication in the antihistamine class, such as hydroxyzine (Vistaril).
Another option that many prescribers rely on to help anxiety/OCD symptoms are beta-blockers and/or antiadrenergic medications, both of which are primarily used to treat high blood pressure. These medications reduce physiological symptoms of anxiety (racing heart, increased blood pressure, trembling, sweating), but do not help anxious thoughts much. Typical meds used for anxiety in the beta-blocker class are: metoprolol (Lopressor); and propranolol (Inderal). Primary care providers commonly prescribe beta-blockers for people who experience performance anxiety, ‘stage fright,’ or significant difficulties with public speaking or performance. Similarly, clonidine (Catapres), an antiadrenergic, can be used to reduce anxiety/OCD.
Lastly, some medical providers prescribe buspirone (Buspar) in place of a benzodiazepine. However, its effectiveness leaves a lot to be desired. And quetiapine (Seroquel), an antipsychotic medication, can be somewhat helpful, especially for anxiety-related insomnia. It primarily ‘tranquilizes’ a person, or sedates them.
Overall, there are many medications that can be useful for treating OCD. The downside is that it may take several months of trial and error to find the right medication(s) for a specific person due to individual biological factors. The most important thing is to work with your primary care provider or psychiatrist closely, do not give up too quickly on a medication as it may take many weeks for a medication to get into a person’s system, and then it may need to be increased.
Thanks for reading, and live happy!