Many people successfully treat OCD with exposure and response prevention (ERP) therapy without medication. For others, combining medication with therapy is a more effective way to manage their symptoms.
Receiving a diagnosis of obsessive-compulsive disorder (OCD) can stir up a lot of feelings—relief at having a name for your experience, worries about your symptoms, or uncertainty about what’s next. If you’re feeling that way, you’re not alone, and there’s good news: OCD is highly treatable, and there are effective options to help you manage it.
Whether or not medication is part of your treatment plan, experts agree that exposure and response prevention therapy (ERP) is essential for managing OCD. ERP is a specialized form of cognitive behavioral therapy (CBT) that helps you face fears and reduce reliance on compulsions, addressing the root of OCD’s challenges and supporting long-term recovery.
As NOCD therapist April Kilduff, LMHC, LCPC, LPCC, explains, “ERP can effectively treat OCD without medication in many cases.” That said, medication can be a lifeline for many people with OCD. Deciding what’s right for you is a personal choice best made with a healthcare provider who understands your unique situation.
In this article, we’ll explore the role of medication, its limitations, and how ERP can often treat OCD on its own. Remember, reaching out to a mental health professional can help you make the choice that’s right for you.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
How is OCD treated?
Typically, OCD is treated with ERP, a specialized form of cognitive behavioral therapy that was created to disrupt the cycle of obsessions and compulsions. Unlike other forms of CBT which are ineffective at reducing OCD symptoms—or in some cases actually make them worse—ERP has been shown to be highly effective for the majority of people who use it.
ERP helps you identify and trigger obsessions while resisting the urge to do compulsions.
By working with a trained therapist who specializes in OCD, you rank your fears from least to most stressful. To start, your therapist will generally encourage you to face a less stressful trigger.
Let’s say, for example, you avoid knives because you have intrusive thoughts of stabbing people. You may start ERP by simply looking at a picture of a knife. The discomfort will likely come up, but you learn to tolerate it instead of fighting it. When nothing bad happens, or you realize you handle the discomfort better than you expected, you start to become more comfortable, and then you progress to more challenging triggers.
Often we will just try ERP first without meds and see if it gives you the progress you need—and for a lot of people, it’s all they need to be in recovery.
April Kilduff, LMHC
The more you face your fears, the more your brain accepts it had nothing to fear in the first place and that compulsions were never necessary to keep you safe. You’ll eventually reach a point where you can be in a room with knives, or perhaps even use knives to make dinner, without being riddled with fear that you’ll lash out and hurt someone.
“Often we will just try ERP first without meds and see if it gives you the progress you need—and for a lot of people, it’s all they need to be in recovery,” says Kilduff.
It’s important to note that ERP can be challenging, and requires intention and commitment. Sometimes, ERP will need to be supplemented with other treatments, which can include medication, acceptance and commitment therapy (ACT), or peer support groups.
Can you treat OCD on your own?
Since ERP is done with a trained mental health professional, treating OCD on your own is not recommended, says NOCD therapist Tracie Ibrahim, MA, LMFT, CST. According to research, only 4% of people with OCD recover without professional help. With a therapist, ERP incorporates exposure exercises, which encourages you to leave your comfort zone. However, when beginning ERP on your own, you might not tackle the right exposures, or begin doing exposures you’re not ready for.
“You may actually do more harm than good if you are not working with a therapist who is evaluating your needs and progress,” Ibrahim said. “Therapists assign ERP homework that is appropriate so that you can continue getting the benefits of OCD outside of sessions, and learn how to incorporate it into daily life when no longer in therapy.”
Any decision to use any form of OCD treatment or medication should be made in consultation with a provider who has specialized training and experience treating OCD. They can help assess your needs and determine the most appropriate treatment plan.
Medications for OCD
Some people find that supplementing ERP with medication can make the process more manageable, especially when symptoms feel overwhelming or progress is slow. Medications don’t cure OCD, but they can provide the stability needed to fully engage in therapy and begin breaking free from the OCD cycle.
Everyone is different. For some people, medication does not help. For others, it may be helpful in reducing symptoms but you still need ERP therapy to help you learn how to react when obsessions come up.
Tracie Ibrahim, MA, LMFT
Let’s take a closer look at the types of medications commonly used for OCD, how they work, and how they can support ERP therapy.
SSRIS
Selective serotonin reuptake inhibitors (SSRIs) are the most prescribed class of medication for OCD. SSRIs are traditionally used to treat depression, anxiety, and post traumatic stress disorder (PTSD) by increasing levels of serotonin in the brain. SSRIs have been shown to reduce symptoms for about 40 to 60% of people with OCD who use them.
TCAs
Tricyclic antidepressants (TCAs) are another type of medication that may be used to treat OCD. They work by affecting both serotonin and norepinephrine, a neurotransmitter that plays a role in your “fight-or-flight” response.
“Everyone is different,” Ibrahim said. “For some people, medication does not help. For others, it may be helpful in reducing symptoms but you still need ERP therapy to help you learn how to react when obsessions come up.”
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How medications for OCD can help
Medications can help some people with OCD tackle the challenges of ERP therapy in several ways:
- Lower anxiety. Many people with OCD have a lot of anxiety, which makes it hard to do ERP therapy. Medications can help take the edge off anxiety and make it easier to tolerate exposure to feared situations or objects, which is a vital component of ERP therapy.
- Better ability to resist compulsions. One of the goals of ERP therapy is to help you learn to resist their compulsions or rituals. Medications can help you experience fewer—and less intense—obsessions and compulsions.
- Better ability to adapt your thinking. People with OCD often have rigid thinking patterns and may struggle to think flexibly or adapt to changing situations. Some medications improve cognitive flexibility, making it easier for you to learn and apply new coping strategies during ERP therapy.
- Improved mood. OCD can be highly distressing and can co-occur with depression or other mood disorders, all of which can affect motivation. Medications can help improve mood and reduce the overall burden of symptoms, making it easier for you to do ERP.
However, no drug addresses the root cause of OCD, so whether you take medication or not, you often need therapy to enjoy lasting results.
If you decide to take medication for OCD, that doesn’t mean you have to take it forever. “Medication makes some patients more able and willing to step in to do some of the scary tasks that we ask people to do in ERP,” says Kilduff. Once patients get the hang of ERP and are in recovery, many patients can work with their doctors to taper off the medication.
“We see whether the successes and gains they got in ERP are maintained or if they kind of start to dwindle as the dose goes down” explains Kilduff. While some people may need medication long-term, many people “realize they can get off the medication and use what they learned with ERP to stay in recovery and to handle lapses when they come up.”
Limitation of OCD medications
While medications can help you manage OCD symptoms, they have several limitations when used without ERP.
First, medication only targets the symptoms of OCD and does not address the underlying psychological factors that contribute to the disorder. Therefore, medication alone might not provide long-term relief from OCD symptoms. “I’ve worked with people who will start with medication because it requires the least effort,” says Kilduff. “They might have a little bit of relief, but not the complete recovery they hoped for, and so, at that point, their only option is to reach out and do ERP therapy.”
Second, medication can have side effects, which some people may not be able to tolerate. Some people may also experience withdrawal symptoms when discontinuing the medications.
“Medications don’t work for everyone,” Ibrahim said. “People with severe OCD symptoms may require higher doses of medication or a combination of drugs. Additionally, some people may not respond to medication at all.”
Alternatives to medication for OCD
Though the first-line treatment options for OCD—ERP therapy and medication—are usually needed to treat OCD, there are strategies that many people use to boost their progress and maintain management of their symptoms over time.
To help you out, your therapist may recommend strategies such:
- Acceptance and commitment therapy (ACT). ACT is a form of behavioral therapy that encourages you to accept your thoughts, emotions, and urges as neutral, rather than as good or bad. Learning to do this might help you do ERP more easily.
- Healthy lifestyle practices. A 2023 study found that OCD patients who exercised more often had better improvement in OCD symptoms during therapy. This can also include having a balanced diet, prioritizing seven to nine hours of sleep each night, and managing stress through mindfulness, meditation, or yoga.
- Family or community support. A 2014 study found that getting family involved in your treatment can have a large impact on OCD symptoms and overall functioning. “Getting family involved can be helpful, since you’ll have other people help hold you accountable,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD.
- Support groups. Having OCD can be isolating when you feel like you’re the only one experiencing the cycle of obsessions and compulsions. It’s comforting to spend time with people who understand and support you, and it can motivate you to stay on top of ERP. “That’s why we have so many support groups at NOCD,” says Kilduff. “Those can be great touch points in between therapy sessions.”
- Deep transcranial magnetic stimulation (TMS). This non-invasive treatment uses electromagnetic pulses to stimulate nerves in the brain. Deep TMS is not a stand-alone treatment and may only be suggested if medications and other therapies have not been successful.
Bottom line
OCD is a highly treatable condition, and recovery is possible whether or not you use medication. Many people find success with ERP therapy alone, while others benefit from adding medication to their treatment plan.
What matters most is finding a treatment plan that works for you. A therapist specializing in OCD can help you explore your options and guide you toward lasting relief. With the right support, managing OCD—and living a fulfilling life—is possible.
Key Takeaways
- OCD is highly treatable without medication. Many people find relief through exposure and response prevention (ERP) therapy, which is often effective even without medication.
- For some, medications like SSRIs or TCAs can reduce symptoms and make ERP more manageable, but they are not required for recovery.
- Everyone’s experience with OCD is different, so working with a therapist who specializes in OCD can help you find the right combination of treatments for your needs.
- Support makes a difference. Whether through therapy, family involvement, or support groups, having the right resources can help you stay on track with treatment and feel less alone in your journey.