Medications known as serotonin reuptake inhibitors (SRIs) have been used for many years to treat OCD. An SRI known as Anafranil has been available the longest and is the best-studied medicine for OCD.
Anafranil has been approved by the FDA to treat OCD in adults and children 10 years of age and above. Although it has been shown to be very effective, it has been associated with some potentially harmful side effects. This has led clinicians to recommend another class of antidepressant medications, the selective serotonin reuptake inhibitors (SSRIs), as the first line of medication treatment. SSRIs directly affect serotonin, a neurotransmitter, or chemical messenger, in the brain. There is growing evidence that SSRIs are as effective as Anafranil in treating OCD, with fewer side effects.
Four SSRIs that have been shown to be effective in treating OCD and are FDA-approved to treat adults with OCD in the United States are:
- Sertraline (brand name Zoloft)
- Fluoxetine (brand name Prozac)
- Fluvoxamine (brand name Luvox)
- Paroxetine (brand name Paxil)
Zoloft, Prozac, and Luvox have also been approved for use with children 6, 7, and 8 years of age and above, respectively.
In some cases, a medication is used “off-label” when it is used to treat a condition or an age group not specifically listed on its prescribing label as an FDA-approved use. For example, although Paxil is not FDA-approved to treat OCD in children, it’s commonly used for that purpose. Two other off-label SSRIs used to treat OCD are:
- Citalopram (brand name Celexa)
- Escitalopram (brand name Lexapro)
Another class of antidepressants affects the neurotransmitters serotonin and norepinephrine. Serotonin-norepinephrine reuptake inhibitors (SNRIs) that have been shown to be effective in treating OCD (although not FDA-approved) are:
- Venlafaxine (brand name Effexor)
- Duloxetine (brand name Cymbalta)
Research has indicated that Anafranil and the SSRIs are generally equally effective. However, for any given person, one drug may be very effective, while others are not. An individual’s medical history, the potential side effects of each medication, and the possibility of an adverse interaction with another drug the person is taking should all be considered when deciding which medication to use.
It’s important to remember that medications for OCD do not work immediately. A person may begin to notice some improvement after a few weeks, but it may take 10 to 12 weeks at therapeutic doses (or longer) to realize the full benefits of a medication.
Physicians should always advise patients about the possible side effects of a given medication. And if the medication must be discontinued, he or she should provide instructions for tapering off the dosage. SSRIs should never be discontinued abruptly.