Selective serotonin reuptake inhibitors (SSRIs) can help treat obsessive-compulsive disorder (OCD), but should be used alongside effective evidence-based treatments, such as exposure and response prevention therapy (ERP).
Obsessive-compulsive disorder (OCD) is a chronic mental health condition that will affect 1 in 40 people over the course of their lifetime. Fortunately, it is highly treatable. While medication is not typically the first line of treatment for most people with OCD, it can play a crucial role in managing symptoms. Selective-serotonin reuptake inhibitors (SSRIs), can help to reduce the intensity of OCD symptoms for some people—especially when paired with exposure and response prevention (ERP) therapy.
ERP is a highly effective, evidence-based treatment that helps people gradually confront their fears and resist compulsive behaviors—leading to long-term symptom reduction. SSRIs can help to regulate serotonin levels in the brain, which can decrease the intensity of symptoms like intrusive thoughts and anxiety. When used in conjunction with ERP, these medications can make it easier for individuals to engage in , or even start, ERP therapy.
A mental health professional can help you develop a personalized plan that may include both medication and therapy. Read on to learn more about what SSRIs are, how they work, and how they can be an effective component of your OCD treatment.
What is OCD?
OCD is a complex, but treatable, mental health condition characterized by two primary symptoms: obsessions and compulsions. Obsessions are recurrent and unwanted intrusive thoughts, sensations, images, feelings, or urges that typically cause distress or anxiety. In response, someone with OCD engages in compulsions—repetitive behaviors or mental acts that are done to reduce anxiety, neutralize a thought or try to prevent a bad thing from happening.
What are SSRIs?
SSRIs are a class of medications designed to increase the availability of serotonin, one of the key neurotransmitters in the brain that plays a role in regulating mood, anxiety, and other emotional processes. SSRIs work by blocking the reabsorption of serotonin in the brain, which increases the amount available to pass between nerve cells. This increased communication between cells can improve mood, reduce anxiety, and alleviate symptoms of conditions like depression and OCD.
Although SSRIs were originally developed to treat major depressive disorder (MDD), they’re also effective for generalized anxiety disorder (GAD), panic disorder, specific phobias, post-traumatic stress disorder, and other mental health conditions—including OCD.
Possible side effects of SSRIs
As with all medications, side effects are possible with SSRIs—though not everyone is impacted. Some more common side effects include:
- Dry mouth
- Agitation
- Insomnia
- Reduced sex drive
- Nausea or vomiting
- Dizziness
- Fatigue
- Diarrhea
- Constipation
- Decreased appetite
- Withdrawal symptoms if stopped abruptly
SSRIs may also cause more severe side effects, such as increased suicidal ideation—especially when starting treatment or adjusting the dose. If you’re experiencing suicidal thoughts or ideation, call a suicide prevention hotline and reach out to your healthcare provider immediately.
Another less common side effect is serotonin syndrome, a rare but serious condition caused by excessive levels of serotonin in the brain, which can lead to high fever, rapid heart rate, and seizures. If you’re experiencing any of these symptoms after starting medication, seek emergency medical care immediately by calling 911 or going to the nearest emergency room.
Many people find that the benefits of SSRIs for OCD outweigh the risks. However, it’s important to talk to your healthcare provider about your own unique needs and concerns. Reach out to your provider if you experience any severe or unexpected reactions. A clinician can help assess whether side effects are temporary, or if adjustments to your treatment plan are necessary.
SSRIs and OCD
SSRIs are the most commonly prescribed medication for OCD. Research shows that about 40 to 60% of people who are prescribed SSRIs for OCD experience partial reduction in their symptoms—something NOCD’s Chief Clinical Officer Dr. Patrick McGrath has observed with his own patients. While we know that serotonin plays a role in the development and regulation of OCD, researchers are still working to understand exactly why SSRIs help alleviate OCD symptoms.
SSRIs tend to work more quickly for anxiety or depression (within two to four weeks), while it may take up to six to 12 weeks to feel the effects for OCD symptoms. “There’s also a chance that the drugs might not work sufficiently,” says Jamie Feusner, MD, and Chief Medical Officer at NOCD. “At that point, a provider might prescribe another type of SSRI or something else entirely.”
Depression is the most commonly co-occurring condition with OCD, and can cause low energy, lack of motivation, and negative thinking, making it harder for individuals to take action—including seeking treatment for OCD. SSRIs—which were originally designed to treat depression—can help reduce these symptoms, offering the motivation necessary to embark on ERP therapy.
SSRIs typically work best for OCD, when used alongside ERP therapy. In some more severe cases where paranoia and/or psychosis is present, SSRIs may be paired with other medications like atypical antipsychotic medicines (such as aripiprazole).
It’s important to note that people can respond to the same medication in different ways, and efficacy and side effects may vary. Factors like genetics, neurobiology, and other mental health conditions may influence how SSRIs impact you. Generally, it’s important to talk to a therapist who specializes in OCD treatment to determine whether SSRIs should be a part of your treatment approach.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Common types of SSRIs
These specific SSRIs are commonly used to treat OCD:
- Fluoxetine (Prozac) for adults and children 7 years and older
- Fluvoxamine (Luvox) for adults and children 8 years and older
- Paroxetine (Paxil) for adults only
- Sertraline (Zoloft) for adults and children 6 years and older
- Celexa (citalopram) for adults only
- Lexapro (escitalopram) for adults and children 12 years and older
While the specific brand names, ages of approval, and dosages vary, these SSRIs all target OCD similarly, by increasing the availability of serotonin in the brain, reducing anxiety, and regulating mood.
SSRIs and ERP
SSRIs are most effective at reducing OCD symptoms, when taken in conjunction with ERP therapy. In ERP therapy, you’ll work in partnership with a therapist, to confront your fears while resisting the urge to perform compulsions in response. To begin, your therapist may have you write down a list of your most distressing obsessions and the compulsions you typically perform to relieve anxiety. This list, known as an exposure hierarchy, can help you and your therapist identify specific situations that trigger your OCD, such as fears of contamination, harming others, or making mistakes.
For example, if your obsessions center on germs and you compulsively avoid public spaces as a result, your exposure hierarchy might start by facing a smaller fear—like touching a door handle—and gradually move to more challenging exposures, such as riding public transportation, or shaking hands with someone.
ERP can feel difficult, since it requires confronting significant fears, but SSRIs can help ease this process by reducing anxiety levels. If you’re having trouble starting ERP, or you find that you’re overwhelmed by the anxiety caused by your intrusive thoughts, consider asking your provider about SSRIs.
Over time, with the help of SSRIs, ERP therapy can help “retrain” your brain, making your obsessive thoughts less overwhelming and reducing the urge to perform compulsions.
How do I get a prescription?
If you think an SSRI might be a good fit for you, make an appointment with a board-certified psychiatrist who specializes in treating OCD. Although any licensed doctor can prescribe you SSRIs, an OCD specialist will have a deeper understanding of the condition and its impact, allowing them to tailor your treatment plan more effectively.
Depending on your individual needs and preferences, SSRIs may provide the boost you need to more effectively move through your ERP therapy, find relief, and regain control over your life.
Key takeaways
- SSRIs work by increasing the levels of serotonin, a neurotransmitter in the brain, which can help reduce the frequency and intensity of obsessive thoughts and compulsive behaviors.
- SSRIs are effective at reducing symptoms of OCD, but their efficacy and side effects can vary from person to person.
- SSRIs are most effective when paired with ERP therapy—which addresses obsessions and compulsions at their root.
- If you think that SSRIs are a good option for you, talk to a mental health professional trained in treating OCD.
