Obsessive compulsive disorder (OCD)


How is OCD Treated?

The two main treatments for OCD are:

  1. Medications: the first-line medications used for OCD are the Selective Serotonin Reuptake Inhibitors (SSRIs).

  2. Cognitive Behavioral Therapy: a specific type of Cognitive Behavioral Therapy known as Exposure and Response Prevention (ExRP) is the most evidenced-based form of therapy for the treatment of OCD.

What Is The Best Medication For OCD?

The first-line medications used to treat OCD are the Selective Serotonin Reuptake Inhibitors (SSRIs). The doses used to treat OCD are typically higher than those used to treat depression and anxiety disorders. The SSRIs include:

  • Citalopram (Celexa)

  • Escitalopram (Lexapro)

  • Fluoxetine (Prozac)

  • Fluvoxamine (Luvox)

  • Paroxetine (Paxil)

  • Sertraline (Zoloft)

Is There A Best SSRI For OCD?

It does not appear that any SSRI works better than any other for the treatment of OCD. However, some people will respond to one SSRI and not respond to another, but currently we are not able to predict which SSRI a given person will respond to and which SSRI he or she may not respond to.

How Often And How Well Do The SSRIs Work For OCD?

When given an SSRI, 40–60% of patients with OCD symptoms will respond. Those who respond will have an average of a 20–40% decrease in OCD symptoms.

What If I Don’t Respond After Treatment With An SSRI?

We will usually try a different SSRI. One review showed that up to 33% of patients with OCD symptoms who did not respond to the first SSRI will respond to the second SSRI.

Are There Other Medications That Are Effective For OCD Besides The SSRIs?

The first medication found to successfully treat OCD was Clomipramine (Anafranil). This is an older medication than the SSRIs from a class of medications called Tricyclic Antidepressants (TCAs). Clomipramine is the only one of the TCAs that has proven to be effective for OCD.

What Is More Effective For OCD — Clomipramine Or The SSRIs?

While meta-analyses suggest greater efficacy for Clomipramine than for SSRIs, results of head-to-head trials do not support this impression and suggest that SSRIs and Clomipramine are equally effective. Given that SSRIs have a less troublesome side effect profile than Clomipramine, SSRIs are preferred for a first medication trial. If a patient does not respond to several SSRIs, we will often try Clomipramine because we sometimes see patients respond to Clomipramine who did not respond to SSRIs.

What Are The Most Common Side Effects Seen With SSRIs?

SSRI Adverse Effects

  • weight gain

  • sexual dysfunction

  • gastrointestinal distress

  • agitation

  • insomnia or somnolence

  • increased tendency to sweat

 Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder is characterized by a preoccupation with one or more perceived defects or flaws in one’s physical appearance that are not observable or appear only slight to others, and by repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking or reassurance seeking) or mental acts (e.g., comparing one’s appearance to that of others) in response to the perceived defects or flaws.

 Hoarding Disorder

Hoarding disorder is characterized by a persistent difficulty in parting with possessions, regardless of their actual value, as a result of a strongly perceived need to save the items and the resultant distress associated with the disposal or absence of such possessions. In the majority of cases, there is also excessive acquisition, which consists of collecting or purchasing extreme quantities of items that are not needed or for which there is no available space. The acquisition of items, coupled with the inability to part with such items, often leads to severe clutter, which can make a living space unusable.

 Trichotillomania (Hair-Pulling Disorder)

Trichotillomania (Hair-Pulling Disorder) is characterized by the recurrent pulling out of one’s hair which results in hair loss and repeated attempts to decrease or refrain from hair pulling. Hair pulling may occur from any region of the body in which hair grows.

 Excoriation (Skin-Picking) Disorder

Excoriation (Skin-Picking) Disorder is characterized by the recurrent picking of one’s skin, which results in skin lesions and repeated attempts to decrease or cease skin-picking entirely. Individuals may pick at healthy skin, at minor skin irregularities, at lesions such as pimples or calluses or at scabs from the previous picking.

 Additional Conditions Treated

In addition, Dr. Poskar treats:

  • Illness Anxiety

  • Obsessive Compulsive Personality Disorder (OCPD)

  • Perfectionism

  • High Functioning Autism

  • Anxiety Disorders

  • Attention-Deficit/Hyperactivity Disorder (ADHD)