OCD and Medication: The SSRIs

If you’ve been dealing with OCD, you’ve probably already had someone mention medication—usually SSRIs. That stands for selective serotonin reuptake inhibitors, and they’re often the first type of medication a doctor will try for OCD. Let’s take a moment to discuss SSRIs, how they work, how safe or unsafe they are, and if you might be a good candidate for them. 

It can feel overwhelming trying to figure it all out while also dealing with the real life, daily symptoms of OCD. Breaking it down step by step can help.

What Are SSRIs?

SSRIs are widely used as a type of antidepressant. However, like a lot of medications,  they are often used to treat illness or ailments other than what they were originally created to treat. SSRIs work by increasing serotonin levels in the brain—a chemical or “neurotransmitter” that helps regulate mood, anxiety, and even obsessive thoughts. Essentially, they help your brain have more serotonin available by slowing down how quickly it gets pulled back into the neuron that released it. That’s what the ‘reuptake inhibitor’ part of the name means—it just keeps serotonin hanging out a little longer so it can do its job of calming your mood and anxiety

In OCD, there’s a kind of glitch in how the brain handles signals about danger or uncertainty. That’s why even when someone with OCD realizes their fear doesn’t add up, it still feels very real (Zhao et al., 2023). Medications like SSRIs help calm that overactive “alarm system” by boosting serotonin in the brain, which makes it easier to dial down the constant worry (StatPearls, 2023)

Which SSRIs Are Commonly Used for OCD?

Not all SSRIs are created equal when it comes to OCD. Some work better than others, and higher doses are usually needed than for depression. According to current research and guidelines, here are the main players:

1. Fluoxetine (Prozac)
2. Fluvoxamine (Luvox)
3. Sertraline (Zoloft)
4. Paroxetine (Paxil)
5. Citalopram (Celexa)
6. Escitalopram (Lexapro) 

Currently only fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and paroxetine (Paxil) have FDA approval for treating OCD. Citalopram and escitalopram don’t have FDA approval for OCD, but doctors often still prescribe them “off-label” for this purpose (International OCD Foundation, n.d.).

Pros and Cons of SSRIs

SSRIs can be life-changing for the right person, but they do have both pros AND cons. Let’s look at these: 

Pros:

• Clinically proven to help OCD: SSRIs are considered a first-line treatment for OCD by most major medical organizations.
• Reduce obsessive thoughts and compulsive urges: Some people feel a major drop in anxiety and intrusive thinking within weeks.
• Can make therapy easier: Feeling less overwhelmed helps people engage in Exposure and Response Prevention (ERP), which is the gold standard therapy for OCD.
• Non-addictive: SSRIs aren’t habit-forming, unlike some anxiety meds like benzodiazepines.

Cons:

• Takes time to work: It can take 6 to 12 weeks (sometimes longer) to feel full effects.
• Side effects: These can include nausea, insomnia, weight gain, sexual dysfunction, or emotional blunting.
• Higher doses needed for OCD: That can increase the chance of side effects compared to when SSRIs are used for depression or anxiety.
• Not a cure: SSRIs manage symptoms but don’t “fix” OCD. Many people need therapy too.
• Withdrawal symptoms: Stopping SSRIs suddenly can cause dizziness, flu-like symptoms, or mood swings.

A Quick Example: Sarah’s Story

Sarah is 26 and has been dealing with a form of OCD called “contamination OCD” since she was a teen. In college, she tried therapy but couldn’t stick with it. Her therapist wanted her to try Exposure Response Prevention (ERP), but she felt too anxious just thinking about exposures. When things got too bad she went to her doctor and Sarah was prescribed fluoxetine. After about two months, she noticed her obsessions were still there—but quieter. She was finally able to return to therapy and start ERP.

SSRIs didn’t erase Sarah’s OCD, but they lowered the volume enough so she could do the hard work of recovery.

Who Might Benefit Most from SSRIs?

SSRIs are usually recommended for people with moderate to severe OCD—especially if the symptoms are interfering with school, work, or relationships.

They might be especially helpful if:

• You’re too anxious to start ERP therapy on its own
• You’ve tried therapy but feel “stuck” or emotionally overwhelmed
• You have OCD and depression (a common combo)
• Your OCD symptoms are constant and distressing, not just occasional

Some studies hint that if someone’s OCD centers more on things like unwanted aggressive, religious, or sexual thoughts—or even symmetry and the need to order things—then SSRIs might work especially well for them (Landeros-Weisenberger et al., 2009). That said, everyone's different—what helps one person might not help another.

Who Should Avoid SSRIs—or Use with Caution?

SSRIs are generally safe for most people, but there are some contraindications and situations where caution is needed:

• Bipolar disorder: SSRIs can trigger mania in people with bipolar disorder.
• History of seizures: Some SSRIs may lower the seizure threshold.
• Pregnancy and breastfeeding: Some SSRIs are safer than others during pregnancy—this should always be discussed with a doctor.
• People on multiple medications: SSRIs can interact with other drugs, including blood thinners and migraine meds.
• Teens and young adults: There’s a small increased risk of suicidal thoughts when starting SSRIs in this age group, especially in the first few weeks (FDA, 2018).

This is why it’s so important to work closely with your treatment team when starting any new medication. Don’t just read a forum or go off someone else’s experience—get professional advice that’s tailored to you.

Best Practices: Getting the Most Out of SSRIs

Starting an SSRI can feel like a big step. Here’s how to make the most of it:

• Be patient: It might take a while to feel better. That’s normal.
• Stick to your dosage: Don’t adjust it on your own! Work with your doctor to find the right dose. NOTE: The dosage is much higher than for depression and anxiety. That adds to the aspect of how quickly you feel the effects - many times you have to go in steps until you reach final dosage.
• Track your symptoms: Apps or journals can help you notice small improvements (or side effects) you might otherwise miss.
• Pair it with therapy: SSRIs work best when combined with ERP, the most effective type of therapy for OCD.
• Avoid stopping cold turkey: If you want to stop the medication, taper off slowly under medical supervision to avoid withdrawal symptoms.

Final Thoughts: Is an SSRI Right for You?

Taking meds for OCD is a personal decision—and one that’s best made with your treatment team. SSRIs aren’t a cure, but they can be a powerful tool in your recovery toolbox. Whether you’re just starting out or you’ve been in treatment for years, it’s okay to explore your options and ask for help.

If you’re feeling stuck or wondering what next steps to take, visit StopOCD.com. They specialize in evidence-based treatment for OCD and offer support for people considering medication, therapy, or both. Whether you want to talk through your options or get help finding the right provider, they’ve got your back.

No one should have to figure this out alone. Help is out there—and you deserve to feel better.

References 

1. Zhao, Y., Zhang, Y., Wang, Q., Manssuer, L., Cui, H., Ding, Q., Sun, B., Liu, W., & Voon, V. (2023). Evidence Accumulation and Neural Correlates of Uncertainty in Obsessive-Compulsive Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 8(10), 1058-1065. https://doi.org/10.1016/j.bpsc.2023.05.011 
2. StatPearls. (2023). Selective Serotonin Reuptake Inhibitors. In StatPearls. Treasure Island (FL): StatPearls Publishing. 
3. Landeros-Weisenberger, A., Bloch, M. H., Kelmendi, B., Wegner, R., Nudel, J., Dombrowski, P., Pittenger, C., Krystal, J. H., Goodman, W. K., Leckman, J. F., & Coric, V. (2010). Dimensional predictors of response to SRI pharmacotherapy in obsessive–compulsive disorder. Journal of Affective Disorders, 121(1-2), 175-179. https://doi.org/10.1016/j.jad.2009.06.010 
4. International OCD Foundation. (n.d.). Medication treatment for obsessive-compulsive disorder (OCD). International OCD Foundation. https://iocdf.org/ocd-treatment-guide/medication/
5. U.S. Food and Drug Administration. (2018, February 5). Suicidality in children and adolescents being treated with antidepressant medications.https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications 
6. Xu, J., Hao, Q., Qian, R., Mu, X., Dai, M., Wu, Y., Tang, Y., Xie, M., & Wang, Q. (2021). Optimal dose of serotonin reuptake inhibitors for obsessive-compulsive disorder in adults: A systematic review and dose–response meta-analysis. Frontiers in Psychiatry, 12, 717999. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.717999/full 
7. Roh, D., Jang, K. W., & Kim, H. (2023). Clinical Advances in Treatment Strategies for Obsessive-compulsive Disorder in Adults. Clinical Psychopharmacology and Neuroscience, 21(4), 676. https://doi.org/10.9758/cpn.23.1075
8. Kayser, R. R. (2020). Pharmacotherapy for treatment-resistant obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 81(2), 19ac13182. https://pmc.ncbi.nlm.nih.gov/articles/PMC7495343/ 
9. Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., & Girardi, P. (2019). Psychopharmacological treatment of obsessive–compulsive disorder (OCD). Current Neuropharmacology, 17(8), 710–736. https://pmc.ncbi.nlm.nih.gov/articles/PMC7059159/