The life of patients with OCD is characterized by more years of disability than that of patients with multiple sclerosis and Parkinson disease combined. Many patients manifest self-stigma symptoms such as shame, embarrassment or guilt. As a result, the time from diagnosis to treatment with medication is nearly eight years! Moreover, studies report that over 50% of people with OCD have at least one comorbid psychiatric condition, typically anxiety or depression. Further, alcohol use disorder is frequent in OCD.
The mainstay of medical management for OCD is medication. The preponderance of evidence supports combined OCD treatment with selective serotonin reuptake inhibitors and cognitive behavior therapy. Most selective serotonin reuptake inhibitors have been shown to be effective in treating OCD both in the acute phase and the maintenance phase. Studies report that patients who benefit from medication typically find that their OCD symptoms are reduced by 40-60%.
SSRIs are the primary pharmacological agents used in the management of OCD. These drugs enhance serotonin neurotransmission, a mechanism believed to be crucial in alleviating OCD symptoms. Not all SSRIs help with OCD symptoms. The medications that do include:
- Fluoxetine (Prozac): Effective in reducing obsessions and compulsions and is approved for both adults and pediatric patients with OCD.
- Fluvoxamine (Luvox CR): Specifically developed and approved for the treatment of OCD in both adults and children.
- Sertraline (Zoloft): Demonstrated efficacy in treating OCD in adults, adolescents, and children.
- Paroxetine (Paxil, Pexeva): Effective in treating OCD but is not approved for pediatric use due to concerns about potential adverse effects.
- Citalopram (Celexa) and Escitalopram (Lexapro): Although not specifically approved for OCD, they are sometimes used off-label due to their SSRI properties.
Importantly, OCD usually requires higher doses of SSRIs than depressive disorders. Patients are typically started on a low dose, which can be incrementally increased based on the patient’s response and tolerance.
Clomipramine (Anafranil): The only TCA approved for the treatment of OCD. It has both serotonergic and noradrenergic properties. Although it has been shown to be effective, it’s generally reserved for cases that don’t respond to SSRIs due to its side effect profile, which includes anticholinergic effects, cardiac effects, and the potential for drug interactions.
The most common strategy for people with OCD who only partially respond to SSRIs is augmentation with other agents.
- Antipsychotics: Drugs such as risperidone, quetiapine, and olanzapine have been studied as augmentation agents to SSRIs. These can be beneficial in people with OCD who also have a tic disorder as well as those who show inadequate response to SSRIs. Guidelines recommend that antipsychotics be administered for only three months, a low to medium dosage.
- Benzodiazepines: While not a primary treatment for OCD, they might be used short-term to manage intrusive thoughts.
- It may take up to 8-12 weeks of treatment with an SSRI at an optimal dose before a clinical response is observed.
- Side Effects: Common side effects of SSRIs include gastrointestinal symptoms, insomnia, fatigue, and sexual dysfunction. Regular monitoring and patient education are crucial to manage these effects and ensure adherence to treatment.
- Drug Interactions: Many of these medications, especially clomipramine, have potential drug interactions. It’s imperative to review the patient’s entire medication list before starting therapy.
- Discontinuation: If a decision is made to discontinue the medication, it should be tapered slowly to minimize discontinuation symptoms.
- Follow-up: Regular follow-up visits should be scheduled to monitor the patient’s response to treatment, adjust dosages, and monitor for side effects.
Medication management is a foundational treatment for OCD. About 50% of OCD patients on medication, stop taking their medication due to side effects or other reasons. At Mercie Health and Wellness, if you have side effects, we can reduce the dosage or work with you to find a different formulation that you may be able to better tolerate so that you can experience the benefits of antidepressants. It is important to take a prescribed medicine for several months to feel the improvement. While many patients benefit from monotherapy with SSRIs, some may require combination treatments or alternative strategies.
When you or a loved one is experiencing distressing thoughts and behaviors, contact Mercie Health and Wellness in Katy, Texas. We can help. At Mercie Health and Wellness we take a humane and personalized approach to treating mental health disorders. Stigma is associated with mental health disorders and can keep a person from seeking help. Don’t let stigma create self-doubt and shame. You will always be treated with respect and dignity at Mercie Health.
At a Glance
Dr. Sylvia Udokoro Nwakanma
- Doctor of Nursing Practice (DNP)
- Double Board Certified in Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) and Family Nurse Practitioner (FNP-C)
- SAMSHA Certified Addictions Nurse Practitioner
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