Serotonin and SSRIs
The primary medications used for OCD are the same ones doctors most frequently prescribe for adult and childhood depression, the SSRI (Selective Serotonin Reuptake Inhibitors) class of antidepressants. These drugs act on serotonin by blocking its “reuptake” by brain neurons, thus leaving more of this chemical in the pathways of the brain's neurotransmitter network. The first SSRI antidepressant medication — called Fluoxetine, brand name Prozac — came on the market in 1986, with several others released in the two decades since.
In this time, the effectiveness of SSRI medications for treating mood and anxiety disorders (including OCD) has been well established. Although there are side effects associated with SSRIs, they cause fewer and less severe side effects than caused by most other classes of psychotropic medications.
There are seven medications currently being prescribed for OCD in adults and children (brand names are listed first, followed by generic names).
Anafranil (Clomipramine)
Prozac (Fluoxetine)
Zoloft (Sertraline)
Paxil (Paroxetine)
Celexa (Citalopram)
Luvox (Fluvoxamine)
Lexapro (Escitalopram oxalate)
All of these medications are SSRIs except Anafranil (Clomipramine), the first medication developed to treat OCD, which is in a category called tricyclic antidepressants. Unlike the SSRIs, a tricylic affects other neurotransmitters in addition to serotonin, primarily norepinephrine and dopamine.
The Massachusetts General Hospital Mood and Anxiety Disorders Institute Resource Center (MADI) 2006 public information on medication for children and adolescents with OCD made the following comments on medication choices and dosage decisions:
Sometimes larger doses of antidepressants (up to four times the standard antidepressant dose) are prescribed to reduce OCD symptoms.
There is no “best” medicine to treat OCD, and it is important to remember that medicines usually reduce, rather than eliminate, symptoms. Different medicines or dosages may be needed at different times in a child's life or to address the emergence of particular symptoms.
The MADI handout also emphasized the need for parents and physicians to pay special attention to special situations, which arise when there are comorbid disorders with a child's OCD. Among the disorders that complicate medication choices are bipolar disorder, where standard SSRI antidepressants can increase manic symptoms, and autism spectrum disorders, where lower dosages of antidepressants (for example, one mg of Prozac) are also needed.
From this list of seven antidepressants commonly prescribed for OCD, three have FDA approval for treating OCD in children.
Anafranil (Clomipramine) for age ten and up
Luvox (Fluvoxamine) for age eight and up
Zoloft (Sertraline) for age six and up
What does approved for use by children mean? The Food and Drug Administration (FDA) requires pharmaceutical companies to perform additional studies on drugs that are already approved for adult use before they are authorized for children. However, doctors will often prescribe drugs for children with OCD prior to those medications receiving this approval. This practice is not uncommon and the medications are not considered unsafe for children; it only means that the drug companies involved have not yet completed all the lengthy FDA testing for the final stage of approval. The use of a medication for OCD by doctors prior to final FDA approval often reflects a doctor's successful use of the particular drug with adults with OCD, and/or new research studies demonstrating its effectiveness or promise for treatment of OCD.
