Medication for OCD: Everything You Need to Know

By Jennifer Nadel, MD
Medically reviewed checkmarkMedically reviewed
July 21, 2022

Obsessive-compulsive disorder, or OCD, is often misunderstood.

People assume that cleanliness, great attention to detail, tics, and quirks, means someone has OCD.

This is a misconception.

With obsessive-compulsive disorder, a person may experience persistent thoughts, or obsessions, and frequent urges to do or perform certain actions, called compulsions.

No matter how hard they try to put these thoughts or actions out of their mind, they find it causes greater distress not to do them or think about them.

For people who experience symptoms of OCD, it can feel like being out of control of their own brain.

In this article, I’ll explore what OCD is, including its symptoms, diagnosis, treatment, and medication options.

I’ll also help you know when you should see a medical professional.

What is OCD?

Obsessive-compulsive disorder is a mental health condition that includes obsessions, which are frequent thoughts or urges, and compulsions, which are repetitive behaviors or actions.

Intrusive feelings or compulsive behaviors linger in someone’s mind when they have OCD, and they may have difficulty distracting themselves from it.

In some cases, the compulsive behaviors may be attempts to distract the mind from obsessive thoughts that will not resolve on their own.

Some examples of obsessive thoughts and compulsive behaviors with OCD may include:

  • Checking the same thing over and over (such as door locks, stove burners being off, light switches off)
  • Keeping items in a specific order, pattern, or location, and feeling distress if this is changed
  • Being overly cautious about germs, dirt, or sanitizing surfaces (and sometimes doing it multiple times in a row)
  • Having persistent thoughts that are disturbing, scary, or of the worst case scenario

Every person who experiences symptoms of OCD is unique.

They may experience entirely different thoughts, compulsions, or behaviors. It may be hard to recognize common symptoms of OCD due to the stereotypes related to the disorder. 

Around 50% of people who have OCD will develop symptoms in childhood or adolescence.

OCD also commonly coexists with other mental health concerns or diagnoses, like anxiety.

People born male will often show symptoms of OCD earlier, but people born female will usually have a more noticeable impact in their life from OCD.

People who are postpartum are up to twice as likely to develop OCD behaviors.

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Symptoms

OCD usually involves different symptoms for obsessions and compulsions.

Some symptoms may overlap, and for some people, they may only have one type of symptom and not the other.

  • Obsession symptoms: Repeated and unwanted thoughts, images, or urges that cause distress, anxiety, or fear. Obsessive thoughts may come out of nowhere. Obsessive thoughts usually have specific themes, such as fear of contamination, fear of the unknown, thoughts of harm, sexual thoughts, or thoughts revolving around order and symmetry. In order to clear these thoughts from the brain, people may develop compulsive behaviors to ward them off or to gain some feeling of control that the horrible thoughts will not actually come to pass.
  • Compulsion symptoms: These are repetitive behaviors that the brain becomes increasingly focused on needing to perform. They usually play a role in silencing obsessive thoughts, reducing anxiety associated with obsessive thoughts, or ritualistic behavior associated with hopes of warding off bad things from happening. Compulsions usually only provide short-lived relief, and then the cycle repeats.

Obsessive-compulsive symptoms feel mentally and physically exhausting, and are often far outside of someone’s control to simply turn off or ignore.

The thought of ignoring obsessions or compulsions can cause significant distress.

Symptoms of OCD can change over time, getting better or worse based on other factors in life, such as stress levels, support system, hormones, and stage of life.

Causes

There are likely many causes or triggers that can lead someone to develop signs of OCD behavior.

Between 45-65% of OCD can be associated with a genetic predisposition.

OCD may also have links to other conditions that impact the brain and nervous system, including:

  • Parkinson’s disease
  • Traumatic brain injury (TBI)
  • Huntington’s disease
  • Tourette syndrome
  • Epilepsy

OCD is more likely to develop in people who have:

  • A family history of OCD
  • Other mental health diagnoses such as depression, anxiety, or tic disorders
  • Experienced stressful or traumatic life events

Diagnosis

Diagnosing OCD is not always a straightforward process. It can appear differently in people.

The average time to a diagnosis is 11 years from the start of symptoms.

This could be because people do not realize that their symptoms are indicative of OCD, or because even though they feel distressed from them, it can feel challenging to ask for and receive help for mental health conditions.

OCD does not have to impact your quality of life.

People may refrain from asking for help because of fear, shame, or guilt.

Your healthcare provider is there to help you, support a good quality of life, and help treat symptoms.

Receiving an OCD diagnosis may involve several steps, such as:

  • Psychological evaluation where you answer questions about or describe your thought patterns, feelings, symptoms, experiences, and behaviors
  • History and physical examination, lab tests, or imaging tests to check for underlying physical causes, or to assess whether other conditions may contribute to your symptoms. Sometimes this is simply done to exclude other medical diagnoses, even if OCD seems like a clear diagnosis. Healthcare providers rule out other conditions because providing an accurate diagnosis is essential to ensuring they can provide effective, safe treatment.

Your healthcare provider will also consider the diagnostic criteria for OCD that is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Treatment

OCD is typically treated with both psychotherapy and medication.

The length of treatment depends on your symptoms, and how you are affected.

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is often recommended for people who experience symptoms of OCD.

In CBT, therapists help people identify and change thought patterns that are negatively influencing them.

Exposure and response prevention (ERP) is a subtype of CBT.

It involves gradual exposure to subjects of obsessive thoughts, and then helps you build resistance and stamina against going to the compulsive behaviors to address them.

This can feel distressing to some people who have OCD, which may make them resist seeking help

Be open and honest with your healthcare provider about what causes distress.

Your healthcare providers will work with you to find safe, effective treatment options.

Your treatment needs and recommendations will be unique to you.

Medications for OCD

The U.S. Food and Drug Administration (FDA) has approved five antidepressants for treating OCD.

These can improve symptoms by changing the way that certain brain chemicals, called neurotransmitters, behave.

This can increase the ability of brain cells to better communicate with each other.

The antidepressants that are used for OCD include one tricyclic antidepressant (TCA) and four selective serotonin reuptake inhibitors (SSRIs):

Antidepressants carry a black box warning, which is the FDA’s most serious notice, that the medication could increase thoughts of self-harm or suicidal ideation.

Antidepressants cause side effects, but most are mild as long as they are taken as directed.

Tell your healthcare provider and pharmacist about any other medications, over-the-counter drugs, and supplements that you take to prevent side effects and interactions.

Your healthcare provider will consider your symptoms and other health factors before recommending a medication for OCD.

Living With OCD

There is not a cure for OCD, but it can be treated.

Psychotherapy and medication together can be very effective for reducing the effect OCD has on a person’s daily life.

It is also important to reduce stress wherever possible, and to have a support system that works for you.

Asking for help, or even telling friends and family members that you are experiencing symptoms of  OCD, can feel overwhelming.

But having trusted people in your life who can support you can be an important part of finding relief from symptoms.

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When to See a Medical Professional

If left untreated or without support, OCD symptoms can interfere with a person’s ability to function in everyday life.

By asking for help from a medical professional and receiving treatment, a person with OCD can regain quality of life and learn to manage their symptoms in ways that cause less distress.

If you are diagnosed with OCD, or you suspect that you have symptoms of it, do not feel afraid to reach out to a medical provider for help.

You are not the cause of the compulsive behaviors or obsessive thoughts related to OCD.

You also do not have to try to fix them on your own, or live in a constant state of trying to manage them privately.

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Frequently Asked Questions

What is the first-line treatment of OCD?
OCD can be treated with psychotherapy and medication. Depending on the severity of symptoms, a person may try psychotherapy first without medication. A healthcare provider will recommend a treatment plan that they believe will be most effective based on your symptoms and other health-related factors.
What is the best medication for intrusive thoughts?
Intrusive thoughts are a common symptom associated with OCD. The FDA has approved five antidepressants for the treatment of OCD, and these medications may be effective for helping to decrease intrusive thoughts.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Jennifer Nadel, MD

Dr. Jennifer Nadel is a board certified emergency medicine physician and received her medical degree from the George Washington University School of Medicine. She has worked in varied practice environments, including academic urban level-one trauma centers, community hospital emergency departments, skilled nursing facilities, telemedicine, EMS medical control, and flight medicine.

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