The second type of treatment is anti-obsessional medication – anti-depressants which are strongly “serotonergic”. They may be used either alone or in combination with behavioural psychotherapy. Your general practitioner or family doctor may refer you to a psychiatrist who will be more aware of the doses required.
Clomipramine (trade name “Anafranil”) was the first anti-obsessional drug in the UK. The dose required may be quite high (250mg or more) and this can lead to some side-effects including:
- blurred vision
- dizziness on standing
- inability to reach orgasm
The newer serotonergic anti-depressant drugs are therefore more widely prescribed. These include:
- fluoxetine (trade name “Prozac”)
- paroxetine (“Seroxat”)
- citalopram (“Cipramil”).
They tend to produce fewer or different side effects to clomipramine. With these drugs a minority of people may experience:
- difficulty in sleeping
- difficulties in reaching orgasm
Most people find the side effects are minor irritations and usually decrease after a few weeks. The drugs are not addictive and you may stop them whenever you wish without experiencing withdrawal symptoms. If and when you do stop taking them, it is however sensible to reduce them slowly.
About 60% of patients with OCD improve with medication. In order to know whether you respond, you may have to take a high dose of the drug for at least 12 weeks. Those people who do respond may find that there is about 50% reduction in symptoms though additional drugs to improve the response. Of those patients that do respond, at least 75% will relapse in the months after stopping the drug. The risk of relapse can be minimised by combining the medication with behaviour or cognitive therapy.
Medication is usually helpful when you are depressed as it may help in improving your motivation to take advantage of a psychological treatment programme. Medication may also be more useful for those who drop out or fail to comply with a programme because of excessive anxiety.