Obsessive-Compulsive Disorder
6 medicines
Obsessive-compulsive disorder (OCD) combines intrusive, unwanted thoughts with repeated actions or rituals carried out to relieve the distress they cause. It's treated with exposure-based therapy and SSRIs such as fluoxetine or sertraline.
Key facts
- Obsessive-compulsive disorder (OCD) combines intrusive, unwanted thoughts (obsessions) with repeated actions or mental rituals (compulsions) carried out to relieve the distress they cause.
- The cycle is self-reinforcing: compulsions bring only temporary relief, so the obsession returns, often stronger.
- First-line treatment combines cognitive behavioural therapy, specifically exposure and response prevention, with an antidepressant; SSRIs such as fluoxetine, sertraline, fluvoxamine, or paroxetine are the usual first choice.
- A full response can take 10 to 12 weeks, and doses used for OCD are often higher than those used for depression.
Obsessions and compulsions
Obsessions are not ordinary worries. They intrude repeatedly and feel alien or shameful; common themes include fear of contamination, fear of unintentionally harming others, a need for symmetry and order, or unwanted sexual or religious thoughts. Compulsions are the behaviours or mental acts a person carries out to neutralise an obsession: hand-washing, checking locks repeatedly, arranging objects, silently counting, or seeking reassurance. Most people with OCD recognise the behaviour is irrational but feel unable to stop without help.
How OCD is treated
The main evidence-based approach pairs cognitive behavioural therapy, specifically exposure and response prevention (ERP), with medication. Several antidepressants are established first-line treatments for OCD, with serotonin reuptake inhibitors as the drug class of choice: fluoxetine, sertraline, fluvoxamine, and paroxetine are common options. When those do not bring enough improvement, clomipramine, an older tricyclic antidepressant with strong serotonin activity, is often tried next. Effective OCD doses are typically higher than those used for depression, and a full response can take 10 to 12 weeks.
When to seek help
OCD rarely resolves without treatment, and symptoms tend to worsen under stress. If intrusive thoughts or rituals take up more than an hour a day, or are affecting work, relationships, or sleep, a mental health assessment is worthwhile. If you are having thoughts of harming yourself, seek help from a crisis line or emergency service right away.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.