The national OCD charity, run by and for people with lived experience of OCD
As a charity we primarily promote psychological therapy (CBT) as the main form of treatment for Obsessive-Compulsive Disorder, however some people will benefit from the addition of medication.
Although medication is not recommended as a sole treatment method, in practice many people will be offered medication whilst on long waiting lists for psychological therapy. If this happens, it should be the service-users choice whether to try medication or not.
This is an important point we have to mention, because some people with OCD have been refused CBT until they take medication. This should not be the case, and the NICE guidelines are quite specific that a patient should be offered a choice of either CBT or medication (or both).
Although we don’t recommend medication as a sole treatment for OCD, if a patient is also suffering with low mood and depression (two common side-effects of OCD) then we encourage users to be open to taking medication, because medication does help many people.
There are several reasons why we don’t recommend medication instead of therapy. Many experts believe that Cognitive Behavioural Therapy is a better treatment approach because it can be faster acting (once accessed) and certainly much longer lasting. It’s also a more cost effective treatment over time than medication and CBT does not involve the risk of side effects. Research also seems to show lower rates of relapse when CBT is discontinued, compared to that of medication, where relapse is more common.
Medication may reduce anxiety enough for a person to start, and eventually succeed, in therapy, with the following analogy often used to explain this. Imagine you’re on a luxury yacht cruise somewhere warm, but you fall overboard, the medication is your life jacket that will keep you afloat treading water, but it’s actually what you learn in therapy that will teach you to swim to safety, and with a bit (or lot) of luck in time you will swim to the island called ‘OCD recovery’.
The types of Medications
The medication used for treating OCD usually take the form of antidepressants which act in the serotonin system, and are called Selective Serotonin Re-uptake Inhibitor, or SSRIs for short.
We do not know exactly why SSRIs are helpful for some people with OCD, it’s thought they might have an effect by altering the balance of chemicals in your brain, but what we do know is that they sometimes reduce the severity of obsessive-compulsive symptoms, by taking the ‘edge’ off some of the anxiety experienced. Some users have described it to us that the anxiety experienced by OCD can feel like a sharp spike, but after taking medication, that sharp spike becomes more of a rounded spike.
Medication types used to treat OCD:
Drugs often have several names. When a drug is first discovered it’s given an approved generic name but since medicines are often made by different companies, they also have one or more brand (trading) names, making it very confusing. The brand name is often chosen to be memorable for advertising, or to be easier to say or spell than the generic name which can often be cumbersome. For example, the generic name for Prozac is Fluoxetine. Whilst the brand name is usually written most clearly on any packaging, you will always see the generic name written somewhere on the packet or leaflet, although often in small print.
Here in the UK there are strict quality controls before a product licence is granted for brand versions of medicines. This means that in theory a generic or brand name version of the same medicine will have the same action and be of the same quality. Although some users have told us that they have noticed a difference, for example in 2015 when Anafranil was discontinued, a handful of users struggled taking the generic version, Clomipramine.
So with each drug recommended for the treatment of OCD we will list both the generic and brand name, if you are confused over medication names, please do discuss with your prescribing doctor.
Selective Serotonin Reuptake Inhibitors (SSRI)
SSRI medications are usually tried first (before non-selective SRIs) because SSRIs only act on serotonin. The SSRIs usually recommended for the treatment of OCD in the UK are:
Generic Name / (Brand Names)
- Citalopram (Celexa, Cipramil)
- Escitalopram (Cipralex, Lexapro)
- Fluoxetine (Prozac)
- Fluvaxamine (Faverin, Luvox)
- Paroxetine (Paxil, Seroxat)
- Sertraline (Lustral, Zoloft)
If these medications fail to work, a non-selective SRI may be prescribed. However, because it affects neurotransmitters in the brain other than just serotonin, there are more side effects and therefore it is usually not a first choice medication for treating OCD. The non-selective SRI most commonly used for treating OCD is:
Tricyclic Antidepressant (TCA)
- Clomipramine (Anafranil)
The NICE guidelines state:
Clomipramine should be considered in the treatment of adults with OCD or BDD after an adequate trial of at least one SSRI has been ineffective or poorly tolerated, or if the patient prefers Clomipramine or has had success in using the medication before.
Typically, the process of determining the most suited medication for an individual is achieved on a trial-and-error basis. However, in order to allow its maximum effects to be adequately observed, each medication should be taken for a specified time period, usually for at least 12-16 weeks, before seeking out an alternative, but always discuss with your prescribing doctor before making any changes to your dosage or type of medication.
This is not an exhaustive list, and sufferers may often be prescribed additional medications to enhance or augment the effects of these SSRIs. For example, part of the criteria to access some of the NHS national treatment clinics is augmentation of medication, which could include anti-psychotic medications alongside SSRI. Although this is a controversial step, with evidence of the effectiveness of anti-psychotics still disputed.
One research summary published by Dr David Veale in 2014 suggested that if they are going to help a patient there is a four week time-frame, that if they are not helping at four weeks, they are unlikely to work for the patient. On his own website blog ‘Comment on Risperidone v CBT for OCD study’, Dr Veale made this comment:
If I was a patient, if I wanted to try another medication then I think I would opt for either the combination of a SSRI with clomipramine or a high dose SSRI.
Medication for Children
For children, the NICE Guidelines for the treatment of OCD suggested that two of the SSRI’s listed had a UK marketing authorisation for treating OCD in children. Those were:
- Fluvoxamine (8 years and older)
- Sertraline (6 years and older)
Although in practice other medications may be prescribed to children, it’s worth pointing out that the NICE Guidelines were published in 2005, so knowledge around using SSRIs for children with OCD will have come on since publication. If a child is prescribed another drug to those listed above, it’s worth asking the prescribing doctor why an alternative medication is being prescribed to their child instead of one of the above two medications.
Medication and side effects
All medications have the potential for side effects, but that does not mean every person will suffer with side effects. We all have different bodies and tolerances to medications, so 10 people could be offered the exact same type, brand and dosage of medication and results will vary from the negative (making them feel worse) through a range of side effects to the positive results without any side effects at all. So it is important you ask a prescribing doctor to discuss the potential side effects with you, Of course the reality is, until you start taking any medication you won’t know if you will have any side effects at all. Click here to read more about potential side effects.
Coming off Medications
Although someone on medication may stop taking SSRIs whenever they wish, we always recommend that they’re reduced gradually under supervision from their prescribing doctor.
It’s also worth pointing out that NICE recommend, that if the medication has helped a person, they should continue taking the medication for at least 12 months to ensure their symptoms continue to improve and to prevent relapses.
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