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Medication

If you and I agree that medication might be a useful adjunct to cognitive-behavioral therapy or behavior therapy (CBT/BT - I use these terms interchangeably), you can be evaluated and treated by a psychiatrist of your choosing or by one I can recommend. I am also comfortable working with psychiatrists or other physicians if you are already on medication. I believe it is essential to take a team approach, and I consider the patient to be an important part of that team.

Medications can help make the therapy go faster and easier, so the combination of behavioral therapy and medication is often recommended. Medication alone is not as effective as BT/CBT at reducing symptoms, and symptoms almost always return when you stop the medication.

The first choice of medications to treat OCD are the serotonin reuptake inhibitors (SRIs); all but one of these affect primarily the serotonin system and are thus called selective serotonin reuptake inhibitors (SSRIs). The SSRIs, with their American brand names in parentheses, are fluoxetine (Prozac, Sarifem), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). The lone SRI is clomipramine (Anafranil). You may see them all referred to as SSRIs. These drugs have an excellent safety profile, but they can have side effects. Common side effects are decreased sexual drive and performance, headache, nausea, insomnia, and drowsiness. Not everyone gets side effects, so fear of side effects is usually not a good reason not to try them. If you do have side effects, they will go away after you stop the medication.

Venlafaxine (Effexor), mirtazepine (Remeron), and the class of drugs known as MAO inhibitors are also sometimes used to treat OCD, but these are not considered first-line treatments. Other medications, such as risperidone (Risperdal), are sometimes used in small doses to "augment" the effects of SRIs.