Obsessive-compulsive disorder: Should I take medicine for OCD?

1. Get the Facts

Your options

Use medicine to help control your obsessive-compulsive behaviors.
Use counseling only.

Key points to remember

If your symptoms are mild, you can try a type of counseling called exposure and response prevention to help control your OCD without medicine.
If your symptoms are severe, medicines (antidepressants) will usually be prescribed first. You may want to start counseling at the same time or soon after you begin medicines.
Antidepressants must be taken as prescribed. If you don't take them regularly, or if you stop taking them, your OCD thoughts and behaviors will probably return.
Antidepressants have some side effects. You may need to try taking different amounts or a different type to find what works best. Many side effects go away a few weeks after treatment starts.
You may need to decide which bothers you more—the side effects of the medicines or your symptoms and anxiety from OCD.

FAQs

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a potentially disabling anxiety disorder. A person who has OCD has intrusive and unwanted thoughts and repeatedly performs tasks to get rid of the thoughts.

For example, if you have OCD, you may fear that everything you touch has germs. And in order to ease that fear, you repeatedly wash your hands.

The effects of OCD range from mild to very serious. Treatment can help. And although some symptoms may continue after treatment, you can go on to have an active social life, raise a family, and work.

What can you expect if you take medicine?

Medicines called antidepressants can help balance the chemicals in your brain and reduce your symptoms. Antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (for example, Prozac), are most commonly used.

Your doctor may increase the amount you take or may switch you to another SSRI if the first one doesn't help or if it causes side effects you can't live with.

You may start to feel better within 1 to 3 weeks after you start to take antidepressant medicine. But it can take as many as 12 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

Your medicine may cause side effects, but they will probably go away after your body gets used to the drug. Common side effects include:

Nausea.
Appetite changes or weight loss.
Headaches.
Trouble sleeping and tiredness.
Nervousness.
Loss of sexual desire or ability, and delayed orgasm.
Dizziness or shakiness (tremor).

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

What can you expect if you don't take medicine?

If you have mild symptoms, you may be able to control OCD with a type of counseling called exposure and response prevention. This is a form of cognitive-behavioral therapy.

With this type of counseling, you gradually increase your contact with the feared obsession so that you have less anxiety about it. For example, if you were obsessed about germs, you would repeatedly touch an object you believe has germs and then not wash your hands afterward. You would repeat that behavior until you felt less anxious about it.
Counseling may also help you think about your beliefs in a new way. For example, if you are a person who washes your hands over and over because you believe germs will harm you, counseling could help you see that you don't need to be afraid.

Why might your doctor recommend taking medicine for OCD?

Your doctor might recommend medicine if:

Your symptoms get in the way of your ability to work and have relationships.
Counseling has not helped control your thoughts and behaviors well enough for you to live with them.

2. Compare Options

	Take medicine for OCD	Use counseling only
What is usually involved?	You take medicine once or twice every day or on certain days of the month. You still visit a counselor regularly.	You visit a counselor regularly. You may need as many as 13 to 20 sessions to relieve your symptoms.
What are the benefits?	Research shows that certain antidepressants improve symptoms of OCD and help balance brain chemicals.	Research shows that counseling helps many people with OCD.
What are the risks and side effects?	Medicine may cause side effects such as nausea, headache, nervousness, or trouble sleeping.	Counseling alone may not be enough to help your symptoms.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Obsessive-Compulsive Disorder (OCD).

Personal stories about taking medicines to treat OCD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I constantly wash my hands. Sometimes even after I have just washed my hands, I feel my hands may not be clean, and so I wash them again. If I touch a public doorknob, shake hands with someone, or touch something another person may have touched, I worry about germs or dirt and feel the need to wash my hands. This behavior is interfering with my life. I think medicines may help control the urge to wash my hands while I continue with professional counseling to learn how to stop this behavior. "

— Jesse, age 41

"I like to have things in my home and office in place and neat. I worry a few times throughout the day whether I left an appliance on or the doors unlocked in my home. I check the locks a few times before I go to work, but I'm not usually late for work due to checking the locks. I don't think the behaviors are interfering in my daily living too much yet. I think I will try to control these worries through professional counseling only. "

— Kyle, age 28

"I worry all the time about my grades at school and how other people see me. I tend to rewrite my papers for school numerous times before I feel like they are good enough to turn in, especially if any of my writing looks messy. I take several showers a day because I worry about how I look. I have also stopped eating in hopes of losing some weight because I worry I weigh too much. In the mornings when I wake up, I can't get out of bed until I have prayed for every family member and friend because I am afraid something bad might happen to them if I forget to pray. If I forget someone, I have to start my prayers all over again, and this often makes me late for school. I have been seeing a professional counselor, but I think I might get more out of counseling if I take medicines that can help me control these urges. "

— Jasmine, age 17

"I spend most of my day reorganizing cupboards and closets in my house. I just can't seem to get them clean enough. I am still able to tend to my children during the day, but when they are napping, I usually spend that time cleaning my house again. I also sometimes think that my buttons are not done up on my clothes and check those throughout the day. However, I can usually stop thinking about my buttons and whether the house is clean when I am involved with my children or have other commitments during the day. I think I will talk with someone about how to resist these urges before they get out of hand, but I don't think I need medicines yet. "

— Carla, age 38

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicine for OCD

Reasons not to take medicine for OCD

I want to do whatever I can to get rid of my obsessions and compulsions.

I can deal with my obsessions and compulsions on my own.

More important

Equally important

More important

I'm willing to try medicine, because I think it will help ease my symptoms and anxiety from OCD.

I think the side effects of the medicine would bother me more than my symptoms and anxiety do.

More important

Equally important

More important

I don't feel that counseling is helping my symptoms enough.

I'm happy with the way counseling is helping my symptoms.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine for OCD

NOT taking medicine for OCD

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. I may not need to take medicine for OCD if my symptoms are mild.

True
False
I'm not sure

That's right. Counseling alone often works to control OCD in people who have only mild symptoms.

2. My decision may depend on whether my symptoms bother me more than the side effects from the medicine would.

True
False
I'm not sure

That's right. You will want to weigh which bothers you more—the side effects of the medicines or your symptoms and anxiety from OCD.

Decide what's next.

1. Do you understand the options available to you?

Yes
No

2. Are you clear about which benefits and side effects matter most to you?

Yes
No

3. Do you have enough support and advice from others to make a decision?

Yes
No

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.