OCD Medications: Antidepressants and Antipsychotics

Key Takeaways

• Around 70% of people with OCD experience benefit from antidepressants known as SSRIs, which can reduce symptoms by 40% to 60%.
• If antidepressants don’t help with OCD symptoms after 10 to 12 weeks, doctors may add an antipsychotic to improve results.

Obsessive-compulsive disorder (OCD) is commonly treated with both medication and cognitive behavioral therapy. Medications that target serotonin pathways in the brain, like antidepressants, are particularly effective in treating people with OCD—and if this doesn’t work, adding on an antipsychotic medication may be useful.

Let’s take a look at the various medications used to treat OCD, including antidepressants and antipsychotics, that have been found to be effective in scientific studies.

What is the most important information I should know about OCD medications?

• Tell your physician about any medications, supplements, or substances you are currently taking before starting a new OCD medication.
• Never stop taking your medication suddenly; doing so may lead to withdrawal or a worsening of condition symptoms.

Antidepressant OCD Medications

About 70% of people with OCD benefit from medication, seeing a symptom reduction between 40% and 60%. The most common antidepressants for treating OCD are selective serotonin reuptake inhibitors (SSRIs).

Although SSRIs are traditionally used for depression, they are also the most effective for OCD. Many people feel their positive effects within two weeks.

FDA-Approved SSRIs for OCD

Four SSRIs are approved by the Food and Drug Administration (FDA) to treat OCD in adults:

• Luvox (fluvoxamine)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

If you do not respond to SSRIs, your doctor may prescribe Anafranil (clomipramine). Anafranil is a tricyclic antidepressant that is FDA-approved to treat OCD. Anafranil may cause side effects such as dry mouth, drowsiness, gastrointestinal issues, and trouble concentrating, among others.

Dosages

When treating OCD, SSRI doses are usually higher than those used for depression. Your primary care provider will probably start you on a low dose to begin and increase it if needed.

The daily dosing of SSRIs for OCD are as follows:

Medication
Starting (mg/day)
Target (mg/day)

Luvox 
50 
300 

Paxil
20 
60

Prozac
20 
80

Zoloft
50 
200 

Be sure to check your prescription and consult your physician to ensure the dose is correct for you. If your symptoms haven’t decreased by about 40% to 50% after 12 weeks, your doctor may adjust your dosage or try a different SSRI.

Off-Label SSRIs for OCD

Most people will experience at least some symptom relief after taking the antidepressants approved for OCD. Many still have residual symptoms, though.

In these situations, healthcare professionals may prescribe other medications “off-label” to try to find a more effective treatment. Two SSRIs-Celexa (citalopram) and Lexapro (escitalopram)-are sometimes prescribed off-label to treat OCD.

Side Effects

Antidepressant medications for OCD, like all psychiatric drugs, may cause side effects. Common side effects include:

Often, these side effects decrease over time as your body adjusts. It’s important to discuss any side effects and concerns with your physician.

When Antidepressants Aren’t Enough

About 40% to 60% of people with OCD do not show a satisfactory response to SSRIs alone. Generally speaking, “response” is defined as a 35% reduction in the Yale-Brown Obsessive-Compulsive Scale (a test that rates the severity of OCD symptoms; Y-BOCS).

If after 10 to 12 weeks SSRIs aren’t significantly alleviating your symptoms, your physician may decide to try augmenting your SSRI with an antipsychotic. Augmenting involves adding a medication, in this case an antipsychotic, to improve the effectiveness of the original treatment.

When to Augment

Augmentation therapy is usually only implemented if Anafranil or SSRIs fail to improve OCD symptoms after at least three months.

Antipsychotic OCD Medications

Two types of antipsychotic medications can be used to treat OCD: first-generation and second-generation antipsychotics. Second-generation antipsychotics, also known as atypical antipsychotic medications, are usually chosen to augment SSRIs.

The following atypical antipsychotics have been found to work well:

• Abilify (aripiprazole)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)

Haldol (haloperidol), a first-generation antipsychotic, may also be used to augment SSRIs in people with OCD. Though Haldol can effectively treat OCD symptoms, it’s been shown to be more likely to cause extrapyramidal side effects (drug-induced movement disorders) in some people than the atypical antipsychotics.

Dosages

When treating OCD, SSRI doses are typically higher than those for depression. Your healthcare provider will likely start you on a low dose and increase it if needed.

Below are some typical dose ranges for antipsychotic augmentation, although actual effective dosages can be different.

Medication
Effective Range (mg/day)

Abilify
15-30

Risperdal
1-2

Seroquel
150-600

Zyprexa
5-10

Experts do agree, however, that using an antipsychotic to augment OCD treatment is nothing like using it for schizophrenia or bipolar disorder. Usually, much lower doses can be used to help treat OCD. In the end, it is really up to your physician to decide the appropriate dose needed to treat your symptoms.

When using an antipsychotic to augment OCD treatment, it’s a good idea to start with a lower dosage. At high doses, some atypical antipsychotics may worsen OCD symptoms.

Side Effects

Antipsychotic medications also have the potential to cause side effects. Some of these include:

Antipsychotic medications are associated with an increased risk for tardive dyskinesia, a movement disorder that causes uncontrollable movements. It also increases the risk of akathisia, which leads to restlessness and an inability to be still.

Timeline and Withdrawal

Don’t expect antipsychotics to immediately impact your symptoms of OCD. You may notice improvements within the first few days of taking these medications. However, it usually takes several weeks to fully experience their benefits.

Some guidelines recommend you take an antipsychotic for at least one year after symptom remission. Discontinuing earlier than that may increase your chances of relapse.

Never stop taking an antipsychotic or change the amount you are taking without your physician’s approval, even if you feel better. Depending on which antipsychotic you’re taking, this can lead to unwanted effects and problems managing your illness.

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Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Owen Kelly, PhD

Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders.

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