Obsessive-compulsive disorder (OCD) and depression are frequently comorbid, meaning they often occur together. Antidepressants with strong serotonergic properties are typically most effective at treating both OCD and depressive symptoms. Because antidepressants increase the levels of the neurotransmitter serotonin in the brain, they relieve feelings of sadness and quiet the obsessive thoughts and compulsive behaviors accompanying OCD. The medications listed below are effective for both depression and OCD.
SSRIs
Selective serotonin reuptake inhibitors (SSRIs) are the first-line approach to treating OCD and depression. SSRIs are not only proven effective at improving symptoms, but the prevalence and severity of side effects is relatively low compared to other pharmacological options. There are many SSRIs on the market, all of which will alleviate depressive symptoms to varying degrees; however, not all SSRIs treat OCD symptoms. More research is needed to determine why certain antidepressants work on OCD symptoms while others do not. Many scientists believe that there are other brain chemicals in addition to serotonin that are involved in OCD, although they do not yet understand all of the chemicals and systems involved. Some antidepressants may alter serotonergic and other brain systems in such a way that alleviates OCD, while others stimulate secondary changes in brain systems that actually make OCD symptoms worse. Only the following SSRIs are shown to be effective at reducing symptoms of both depression and OCD:
• Fluvoxamine (Luvox)
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram (Celexa)
In can take weeks for SSRIs to start showing any positive effects on symptom reduction, and your physician may frequently have to alter the dose or type of medication before finding one that works best for you.
Side effects of SSRIs include nausea, dry mouth, headache, dizziness, fatigue, sexual side effects, sleep disturbances, and weight loss or gain.
Tricyclics
Clomipramine (Anafranil) is a tricyclic antidepressant that effectively improves symptoms of OCD and depression. Because tricyclics can cause more serious side effects than SSRIs, they are usually not prescribed unless other drugs have failed to produce symptom relief. Serious side effects of clomipramine include confusion, seizures, difficulty breathing, hypotension, shaking (pseudoparkinsonism), arrhythmias and hallucinations.
Antipsychotics
Treatment-resistant cases of depression and OCD may respond to low doses of atypical antipsychotic medications such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel) and ziprasidone (Geodon). Doses that are too high can actually promote the development of extreme obsessions and compulsions in addition to other side effects that include weight gain, diabetes, elevated cholesterol and cardiovascular disease. For these reasons, atypical antipsychotics are only prescribed in hard-to-treat patients whose illness has proven resistant to other medications.
References
- International OCD Foundation: OCD Medication
- NAMI: Commonly Prescribed Psychotropic Medications
- "Primary Care Companion to the Journal of Clinical Psychiatry;" Metabolic adverse events in patients with mental illness treated with antipsychotics: a primary care perspective; Balf G et al.; 2008
