There are two primary types of OCD medications: tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). A doctor may prescribe a TCA or SSRI by itself or in combination with a variety of other medications. As no one medication works for everyone, those with OCD should expect to have to try different medications at various dosages before finding the one that works best. Like with all medications, SSRIs and TCAs have multiple side effects.
TCAs, developed in the early 1950s, were the first OCD medications available. TCAs work by increasing the brain's serotonin level. Besides having an effect on OCD, TCAs were widely prescribed for other mental conditions such as clinical depression and attention deficit hyperactivity disorder. With the development of SSRIs, the use of TCAs has dropped significantly. Doctors still prescribe TCAs when SSRIs prove ineffective.
Though the medication has a similar effect on brain chemistry, SSRIs became more popular over time due to a number of factors. One of the most significant is that SSRIs have less serious side effects. Also, a patient cannot fatally overdose on SSRIs, a benefit as these medications are prescribed to patients who are possibly mentally unstable. SSRIs, unlike TCAs, have a gradual effect on brain chemistry. Though a course of medication can take a year or longer, a patient is less likely to suffer the effects of unbalanced brain chemistry.
A patient will sometimes take a combination of OCD medications. The most common pairing is a TCA with an monoamine oxidase inhibitor (MAOI). MAOIs are strong antidepressants. Some evidence has shown that combining these two types of drugs has a greater effect on OCD than just a TCA. As the combination can be lethal, MAOIs are very rarely paired with SSRIs.
As all OCD medications have a slightly different effect on the brain, finding the right one can take time. A doctor will usually start by prescribing an SSRI. After a trial period, doctor and patient will meet again to discuss any progress. If none has occurred, the patient will discard the first SSRI and begin taking another. If the patient is completely unresponsive to SSRIs, the process begins again with TCAs.
OCD medications have noticeable, sometimes significant side effects. A few symptoms are common to all OCD medications: sexual dysfunction, dry mouth and difficulty sleeping. Specific to TCAs, some patients report weight gain and feelings of anxiety. Patients taking SSRIs can experience drowsiness, nausea and headaches. Reporting side effects to one's doctor is advised as a different OCD medication may provide a higher quality of life while still effectively treating one's OCD.