Treatments and drugs

By Mayo Clinic Staff

Obsessive-compulsive disorder treatment may not result in a cure, but it can help you bring symptoms under control so they don't rule your daily life. Some people need treatment for the rest of their lives.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

Psychotherapy

A type of therapy called exposure and response prevention (ERP) is the most effective treatment. This therapy involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn healthy ways to cope with your anxiety. Exposure therapy takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

Therapy may take place in individual, family or group sessions.

Medications

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants that have been approved by the Food and Drug Administration (FDA) to treat OCD include:

  • Clomipramine (Anafranil)
  • Fluvoxamine (Luvox CR)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)

However, other antidepressants and psychiatric medications used for other conditions may be prescribed off label to treat OCD.

Choosing a medication

With OCD, it's not unusual to have to try several medications before finding one that works well to control your symptoms. It can take weeks to months after starting a medication to notice an improvement in your symptoms. Your doctor also might recommend combining medications, such as antidepressants and antipsychotic medications, to make them more effective in controlling your symptoms.

Don't stop taking your medication without talking to your doctor, even if you're feeling better — you may have a relapse of OCD symptoms. Antidepressants aren't considered addictive, but sometimes physical dependence, which is different from addiction, can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

Medication side effects and risks

In general, the goal of OCD treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Here are some things to consider:

  • Side effects. All psychiatric medications have potential side effects, which may include stomach upset, sleep disturbance, sweating and reduced interest in sexual activity. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric medications. And let your doctor know if you experience troubling side effects.
  • Suicide risk. Most antidepressants are generally safe, but the FDA requires that all carry the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur when taking an antidepressant, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
  • Interactions with other substances. Some medications can have dangerous interactions with other medications, foods, alcohol or other substances. Tell your doctors about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Other treatment

Sometimes, medications and psychotherapy aren't effective enough to control OCD symptoms. Research continues on the potential effectiveness of deep brain stimulation (DBS) for treating OCD that doesn't respond to traditional treatment approaches.

Because DBS hasn't been thoroughly tested for use in treating OCD, make sure you understand all the pros and cons and possible health risks.

Aug. 09, 2013