Understanding OCD Medication
When should I consider prescription drugs?
For some people, mindfulness and therapy are not enough. Medication can be used in combination to seek better results. According to the International OCD Foundation, about 70% of OCD patients benefit from medication. However, of that 70%, about half stop medication due to negative side effects or other reasons. Those that continue treatment, see a 40-60% reduction in OCD symptoms on average. Medication is not for everyone. It’s crucial that you consult a doctor before considering medicinal options.
Medication can be offered at different points in a person’s journey. Some try medication before entering therapy. Others try medication after or during therapy. Many doctors recommend trying ACT/ERP therapy and mindfulness activities prior to starting medication to see if symptoms can be managed without drugs. That said, every journey is different and some patients prefer to stabilize on meds prior to beginning professional care.
OCD Medication & Therapy
What are SSRIs and how do they impact intrusive thoughts?
The main family of medicines used to treat OCD are known as Selective Serotonin Reuptake Inhibitors, or SSRIs. SSRIs enhance your natural serotonin activity and are used to treat major depressive disorders and anxiety conditions.
Common examples of SSRIs used to treat OCD include Lexapro, Prozac, Paxil, Zoloft, Celexa, Effexor, Anafranil and Luvox. Not all SSRIs will be effective in treating OCD and medication that works for one person may not work for another. It’s crucial that you don’t base your drug choices on other people’s experiences. SSRI use must be determined and monitored by a professional.
Side effects are common with SSRIs. Because of this, patients must make it a priority to remain open with their doctor about how they’re feeling. If an SSRI is greatly impacting your ability to work, socialize and perform daily tasks, it may be time to stop treatment. If you are pregnant or breastfeeding, consult your doctor about the potential risks of medication. Many SSRIs are safe to take during pregnancy but there is potential for side effects. Learn more here.
How do SSRIs help with anxiety?
Serotonin is a chemical messenger that helps carry signals between brain cells, also known as a neurotransmitter. Other neurotransmitters include dopamine and norepinephrine.
When serotonin is inside a brain cell, it has a neutral effect. It needs to be outside of the cell to activate. An SSRI blocks the reuptake of serotonin after it's been released so that more serotonin builds up outside of our neurons. It’s called a “selective” serotonin reuptake inhibitor because these medication focus specifically on serotonin and not other neurotransmitters. Other drugs, like SNRIs and NDRIs, focus on dopamine and norepinephrine reuptake.
Serotonin is believed to help regulate important functions, including mood, appetite, sleep, memory, sexual desire and social behavior. It plays a key role in the central nervous system and the gastrointestinal tract. Studies have linked serotonin with bowel function, bone density, nausea and clotting, in addition to its effect on mood.
It is not completely understood why SSRIs are effective for anxiety disorders. However, after years of research and application , they have proven to work for many patients.
Are there side effects or warnings?
As with most prescription medications, there are side effects to SSRIs. No one should take an SSRI, or make changes to their medication plan, without consulting a doctor. If you are pregnant or breastfeeding, consult your doctor about the potential risks of medication. Many SSRIs are safe to take during pregnancy but there is potential for side effects. Learn more here.
Common side effects include drowsiness, nausea, dry mouth, insomnia, diarrhea, agitation, dizziness, headaches, rapid heart rate and sexual dysfunction. Not everyone will experience these side effects. If you are, you should reach out to your doctor to discuss a possible switch.
Some people experience an increase in suicidal thoughts on SSRIs. If you are experiencing thoughts about hurting yourself, you should call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255.
A less common side effect is something called Serotonin Syndrome. This occurs when too much serotonin builds up in your system, and is normally the result of mixed medications. Symptoms often kick in within a few hours of mixing serotonin related drugs, and include confusion, dilated pupils, headaches, changes in blood pressure, nausea, diarrhea, tremors, shivering and heavy sweating. In severe cases, it may cause high fevers, seizures or unconsciousness. If you think you are experiencing Serotonin Syndrome, call a doctor or 911.
It’s important to remember that SSRIs affect everyone differently. And it takes time for your body to adjust to them. 6 to 8 weeks is the standard amount of time for effects to be felt. If you have not noticed any benefits by the 8 week mark, reach out to your doctor. Prior to that point, be patient. Let the medication get into your system and have a shot at working.
From the Community
When do I take SSRIs?
SSRIs are a daily medication. They should not be taken solely at moments of intense stress like beta blockers (drugs that control adrenaline). They should be worked into your everyday routine.
The time of day you take your meds is up to you and your doctor. It is possible to optimize their effects by working with your schedule. However, this is an individual experience and no one answer applies to all patients.
It’s important to continue your SSRIs even when you start feeling better. They aren’t a quick fix, they are an ongoing management tool for anxiety. If you stop treatment after seeing results, negative symptoms will likely return. Doctors often recommend that patients stay on an SSRI for at least one year to experience full effects.
If I’m interested in trying them, where should I go?
Any licensed medical doctor can prescribe SSRIs. However, it is recommended that people work with psychiatrists rather than general practitioners when it comes to mental health related medications. Psychiatrists will have a better understanding of your condition and any possible comorbidities. In the case of OCD, you should try and find a psychiatrist who specializes in severe anxiety disorders and has past experience treating other OCD sufferers.
Once you set up an appointment, you’ll be asked to describe what you’re going through — your symptoms, their duration, the impact they have on your day-to-day, other treatments you’ve tried, etc. It’s important that you are candid and open with your doctor when having these conversations. From there, you’ll work together to come up with a treatment plan. In many cases, this plan includes a combination of medication and therapy.
If you do not have insurance, you can ask your doctor to prescribe the generic version of a drug. These will be cheaper, and often have the same effects as a brand name version. Many drug companies also have programs that assist people in accessing medication when they cannot afford it. These drugs may be free or sold at a reduced cost. You can find out more at the PPA (Partnership for Prescription Assistance) website, or call them at 1-888-477-2669.
I’m afraid. Should I be?
Treatment can be scary, so don’t feel ashamed if you’re intimidated or hesitant. It’s a totally normal response to have! That said, a doctor will work with you in deciding the best course of action based on your specific symptoms. They’ll be there to answer questions, schedule check-ups, and help you understand what’s going on. You’re not in this alone.
It also helps to open up to family, friends and/or partners about your treatment journey. Some people like to find local or online support groups for additional guidance. Leaning into your community can be life changing when it comes to starting medication. It can also help to have someone close to you monitor your behavior changes as you adjust to drugs. It can be hard to understand the impact a medication is having when you’re the one effected. Often times, an outside observer will pick up on changes that you wouldn’t have.
Lastly, remind yourself that recovery isn’t linear and that there is no easy solve to anxiety. You’ll have ups and downs, even on medication. You’ll struggle to make a decision about the right kind of treatment. You may doubt the choices you’ve made. The important thing is that you’re learning and trying. No one gets this right immediately. It’s an ongoing process that requires patience and understanding with yourself.