Obsessive-compulsive disorder (OCD) is a chronic, often debilitating mental health condition that affects 1 in 40 people. The most effective treatment is exposure and response prevention (ERP) therapy, often paired with medication to reduce symptom severity.
Medication can make ERP therapy more manageable, especially if symptoms are intense or co-occurring conditions are present.
In this guide, you’ll learn how medications help manage OCD, which ones are prescribed, what doses are used, and how to get started.
How can medication help manage OCD?
Medications can reduce the intensity of OCD symptoms, making ERP therapy more effective.
Prescribers may recommend medication if:
- OCD symptoms are severe or treatment-resistant
- You have co-occurring conditions like anxiety, depression, or PTSD
- ERP therapy alone feels too distressing to complete
- You prefer a combined approach
Research shows that SSRIs combined with ERP therapy are more effective than SSRIs plus stress management. In one study, 74% of people doing ERP and SSRIs experienced around a 25% reduction in OCD symptoms—compared to only 22% in the control group.
“Medication by itself typically doesn’t remove OCD symptoms 100%,” says Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD. “If a person gets a 35% reduction of symptoms, that’s considered a full response—just like it is for ERP. On average, people taking medications have around a 30-50% reduction in symptoms.”
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Types of OCD medications
Three main classes of medications are used to treat OCD:
1. Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are the first-line medications for OCD. They increase serotonin signaling in the brain, which can help reduce anxiety and obsessive thoughts over time.
Common SSRIs for OCD include:
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Escitalopram (Lexapro)
- Citalopram (Celexa): Not usually first-line due to dosage limitations
- Venlafaxine (Effexor): An SNRI sometimes used when SSRIs are ineffective
SSRIs are prescribed at higher doses for OCD than for depression or anxiety—sometimes up to five to six times higher.
SSRI side effects:
- Nausea
- Dizziness
- Dry mouth
- Insomnia or drowsiness
- Sexual side effects
- GI issues
- Mild withdrawal if stopped abruptly
Rare but serious: Serotonin syndrome—seek emergency care if you experience high fever, tremors, or seizures.
Dr. Feusner says that SSRIs typically take 6-12 weeks to show an effect on OCD symptoms.
2. Tricyclic antidepressants (TCAs)
Clomipramine (Anafranil) is the only TCA commonly used for OCD. It affects both serotonin and norepinephrine, and is FDA-approved for OCD in individuals aged 10 and up.
Clomipramine is typically prescribed when two or more SSRIs are ineffective. It may also be combined with an SSRI for additional benefit.
Clomipramine side effects:
- Dry mouth
- Constipation
- Low blood pressure
- Sexual side effects
- Weight gain
Like SSRIs, it may take 6-12 weeks to reduce OCD symptoms.
3. Atypical antipsychotics
Atypical antipsychotics are used as augmentation, not standalone treatments for OCD.
These medications affect dopamine and serotonin pathways, and are sometimes prescribed when SSRIs alone aren’t effective.
Common choices include:
- Aripiprazole (Abilify)
- Risperidone (Risperdal)
- Haloperidol (Haldol): A typical antipsychotic with some evidence as a second-line augmentation
Side effects:
- Nausea and vomiting
- Headache
- Drowsiness
- Weight gain
- Restlessness
- Tremors
- Rare but serious: Tardive dyskinesia with long-term use
OCD medications for children
Medication is often combined for children with moderate to severe OCD.
FDA-approved medications for pediatric OCD include:
- Fluoxetine (ages 7+)
- Fluvoxamine (ages 8+)
- Sertraline (ages 6+)
- Clomipramine (ages 10+)
Always consult a pediatric psychiatrist or OCD specialist to determine the safest option.
Typical doses for OCD medications
People with OCD often need higher doses than those prescribed for depression.
Here’s a quick reference:
| Medication | Drug class | Level of medication | Dose (mg) |
|---|---|---|---|
| Fluoxetine (Prozac) | SSRI | First-line | 40-80 mg |
| Fluvoxamine (Luvox) | SSRI | First-line | 200-300 mg |
| Paroxetine (Paxil) | SSRI | First-line | 40-60mg |
| Sertraline (Zoloft) | SSRI | First-line | 100-200 mg |
| Escitalopram (Lexapro) | SSRI | First-line | 20* mg |
| Clomipramine (Anafranil) | TCA | Second-line or as augmentation | 100-250 mg |
| Aripiprazole (Abilify) | Atypical antipsychotic | Augmentation | 2-20 mg |
| Haloperidol (Haldol) | Typical antipsychotic | Augmentation | 2-10 mg |
| Risperidone (Risperdal) | Atypical antipsychotic | Augmentation | 0.5-3 mg |
*Clinical trials have demonstrated effectiveness with doses as high as 30 and 50 mg/day. However, >20 mg/day increases the risk of QT prolongation, and caution is advised when using doses greater than 10 mg/day in patients older than 65. Additionally, for doses above 20 mg/day, regular electrocardiogram monitoring is recommended.
Your prescriber should provide further details on the specific doses necessary to reduce your OCD symptoms.
Who shouldn’t take OCD medications?
Certain medications or conditions may interact negatively with OCD medications.
For example, some potential contraindications for SSRIs include:
- MAOIs or other drugs that increase serotonin
- Pimozide
- Herbal supplements like St. John’s Wort, SAMe, or 5-HTP
Always share your complete medication list and medical history with your healthcare provider to avoid potential interactions.
How to get a prescription for OCD medications
In the U.S., OCD medications can be prescribed by:
- Psychiatrists
- Primary care doctors
- Nurse practitioners
- Physician assistants
It’s crucial that you seek guidance from a provider with specialized training in OCD. “Specialists will be comfortable prescribing these medications at the doses that are most effective, but prescribers who are not as familiar with OCD might only go to a certain, lower dose, and this could be a problem, as OCD doses are typically higher than typical antidepressant doses,” explains Dr. Feusner.
To find the right prescriber:
- Use the IOCDF provider directory
- Book therapy with an NOCD Therapist, who can refer you to a trained prescriber
Bottom line
OCD medications can reduce symptoms, but they work best when combined with ERP therapy.
SSRIs are the first-line option, and other medications may be added when needed. If you’re struggling to manage OCD, consider a combined approach and consult a provider who understands OCD-specific treatment.
