Which medications are used in the treatment of obsessive-compulsive disorder (OCD)?

Updated: May 17, 2018
  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

Only antidepressants that potently inhibit presynaptic reuptake of serotonin appear to be effective in treating obsessive-compulsive disorder (OCD). Clomipramine (Anafranil) is the only tricyclic antidepressant (TCA) with this quality. The selective serotonin reuptake inhibitors (SSRIs) are also effective. SSRIs have the advantages of ease of dosing and low toxicity in overdose. Available SSRIs include fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft).

SSRIs or clomipramine should be advanced as tolerated to a therapeutic dose. Clinical response may take 6-10 weeks to become apparent. The clinician should review adequacy of dose, duration of therapy, and compliance before deciding that a medication is ineffective.

SSRIs are generally preferred over clomipramine in treating OCD. The adverse effect profiles of SSRIs are less prominent, so improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with TCAs; however, citalopram causes dose-dependent QT prolongation. [36, 37] Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered when treating a child or adolescent with mood disorder.

Antipsychotics, such as haloperidol, olanzapine, and risperidone, have been used with some success in augmenting SSRIs in patients with OCD, particularly in patients with comorbid Tourette disorder or other tic disorders. [18]

A Cochrane review found some evidence of efficacy for quetiapine or risperidone as a general augmentation strategy (not specifically for those with comorbid tics). [38] However, heterogeneity was noted in doses used and in response, and the number of subjects in these studies was generally small

The dual serotonin-norepinephrine reuptake inhibitor antidepressants (SNRIs) venlafaxine (Effexor) and duloxetine (Cymbalta) may also have efficacy in OCD, and they have safety and tolerability profiles comparable to those of the SSRIs. However, neither has yet been FDA-approved specifically for treatment of OCD.


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