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Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• The selective serotonin reuptake inhibitor (SSRI) group of medications is usually considered to be the most desirable treatment for OCD. This is also true for OCD symptoms that occur in the context of autism spectrum disorders. Examples of SSRI medications include sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). The possible side effects of this group of medications can vary greatly from person to person and depend on which medication is being used. Common side effects of SSRIs include dry mouth, sexual dysfunction, nausea, tremors, trouble sleeping, blurred vision, constipation or soft stools, and dizziness. For this group of medication, missing one or more doses may result in sufferers experiencing achiness, tiredness, or stomach upset.
• Tricyclic antidepressants (TCAs) have also effectively treated OCD. Examples of TCAs are clomipramine (Anafranil), amitriptyline (Elavil), and imipramine (Tofranil). Many TCAs are less well tolerated than the SSRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance-abuse disorders. Examples of benzodiazepines include clonazepam (Klonopin), lorazepam (Ativan), and alprazolam (Xanax). In very rare cases, some people have been thought to become more acutely more anxious or depressed once on any antianxiety/antidepressant medication, even trying to or completing suicide or homicide. Although debate continues about whether the medication or the illness itself is the cause of this rare complication, it is thought to be more likely to occur in children and teens.

As about 50% of people who receive an adequate trial of SSRI medication fail to experience an adequate decrease in OCD symptoms, the use of other medications and psychotherapies is important. For people who do not respond robustly to the combination of psychotherapy and one medication, some OCD sufferers may improve with the addition of one of the following medications:

• Antipsychotic medications, like olanzapine (Zyprexa), risperidone (Risperdal), or quetiapine (Seroquel): Except in individuals who also suffer from bipolar (manic depressive) disorder, it is unclear about how frequently these medications are beneficial in this way.
• Anticonvulsant medications like divalproex sodium (Depakote) or carbamazepine (Tegretol) that have been used to treat bipolar disorder may also be of use in people who simultaneously suffer from both bipolar disorder and OCD.

While certain subtypes of OCD may tend to respond more or less robustly to psychotherapy versus medication, there is enough variability in how individuals respond to treatment that either antipsychotic or antiseizure medication treatment is often considered in each person with OCD.

• In treating postpartum OCD, time is of the essence during this critical time of maternal-infant bonding. Therefore, sometimes faster-acting medications like tramadol (Ultram) are used to treat this disorder. Tramadol is a pain reliever that increases the activity of serotonin, epinephrine, norepinephrine, and opiates that naturally occur in the brain and works rapidly. This is in contrast to medications like the SSRIs, which can take weeks to work.

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