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Biological explanations of OCD emphasise the role of the brain chemical serotonin. Treatment consists of certain anti-obsessional medications that are strongly ’serotonergic’ (this basically means they have an effect on serotonin). The medication may be used either alone or in combination with cognitive behaviour therapy.

Although a person’s general practitioner can prescribe this medication, s/he may refer the person to a psychiatrist.

About 60% of patients with OCD improve with medication. In order for a person to know whether s/he responds, s/he may have to take a high dose of the drug for at least 12 weeks.

The newer selective serotonin reuptake inhibitor (SSRI) drugs are more widely prescribed. These include: Fluoxetine (trade name ‘Prozac’); Fluvoxamine (’Faverin’); Sertraline (’Lustral); Paroxetine (’Seroxat’); Escitalopram (’Cipralex’) and Citalopram (’Cipramil’). All these drugs can be effective but one person may get a better response to one than another. As a result, at least three are usually tried before concluding that they have no benefit.

Clomipramine (trade name ‘Anafranil’) was the first anti-obsessional drug available in the UK but this is less commonly prescribed now. The dose required may be quite high (250mg or more) and this can lead to some side effects including: dry mouth, blurred vision, constipation, drowsiness, dizziness on standing, and inability to reach orgasm.

In individuals who do not respond to anti-obsessional drugs, other medications may also be prescribed, such as Risperidone (trade name in UK ‘Risperidal’), Haloperidol (’Haldol’) or Sulpiride (’Dolmatil’). These drugs are probably only useful in a low dose in a few patients, as an additional treatment to anti-obsessional drugs, and after a number of anti-obsessional drugs have already been tried fully. They are not thought to be helpful if used alone. They have different side effects such as stiffness in the limbs or slurred speech that can be countered by other medication. In low doses the drugs may help to reduce anxiety. In more severe cases, there are other drugs that may be added to improve the response.

SSRIs tend to produce fewer side effects than clomipramine. With these drugs, a minority of people may experience nausea, diarrhoea, headache, difficulty in sleeping, restlessness or difficulties in reaching orgasm. Most people find the side effects are minor irritations that usually decrease after a few weeks. Although the patient may stop taking SSRIs whenever s/he wishes, it is sensible to reduce them under supervision.

If you have any concerns regarding your medication, please speak to your GP or whoever prescribed the treatment.

Tags: Drugs, Medication

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