Can Lexapro Be Used for OCD?

Lexapro (generic name: escitalopram) is a type of antidepressant called a selective serotonin reuptake inhibitor, more commonly known as an SSRI. It’s used to treat major depressive disorder, anxiety disorders (including generalized anxiety disorder), and OCD. It may be used for short-term treatment or long-term treatment and prescribed to adults or older children.

How does Lexapro Work?

Like the class of drugs suggests, Lexapro works by inhibiting the reuptake of serotonin. This is similar to several other antidepressants and, in simple terms, just means the drug blocks the reabsorption (or reuptake) of serotonin in the brain, ultimately increasing the amount of serotonin available and improving important communication between the brain’s neurons.

But what is serotonin in the first place? And why is it important to human health? Serotonin is a neurotransmitter, a type of molecule that effectively acts as the body’s chemical messenger. It’s a highly important part of the nervous system, making up the telephone lines that allow neurons to submit messages to each other and elsewhere.

After serotonin does its job, it undergoes a process of reuptake where it is reabsorbed and recycled. This is the process, as mentioned above, that Lexapro and other SSRIs block, making more serotonin available for use. More availability is key to people with depression and anxiety; since serotonin is dubbed the “feel-good hormone,” it’s not surprising that it helps people feel better.

Serotonin isn’t limited to affect and anxiety; it has a role in all sorts of processes, from your mood and your sleep schedule to whether you go back for a second helping of your mom’s meatloaf and how quickly you learn to drive a stick shift or memorize a Shakespearean soliloquy. It even has a role in things like body temperature and the all-important breathing.

Why is Lexapro Effective for OCD?

Like those with many other mental conditions, OCD sufferers demonstrate lower-than-average levels of serotonin. The effects of this aren’t completely known but it’s hypothesized that low serotonin can lead to intrusive thoughts as well as the tendency for the OCD sufferer to believe their thoughts (as opposed to someone without OCD who is able to simply ignore or disregard these intrusions). Intrusive thoughts are what make OCD OCD….with compulsions as costars.

Low serotonin can leave the brain’s “wires” crossed, mixing up the messages the molecules transmit. It’s similar to the children’s game of Telephone; the message is innately benign but, through miscommunication, becomes a threat. This is why someone with OCD might touch a doorknob, an act that conveys no harm in reality, and end up believing they’ve been exposed to a deadly virus. The harmless message becomes harmful without the necessary serotonin to regulate it.

In this way, low serotonin leads to compulsive behaviors as well; the OCD sufferer who touches a doorknob and buys into the intrusive thought that their health is at risk will spend a significant amount of time washing their hands over and over as part of their OCD cycle. They might scour and scrub every finger for five minutes, ten minutes, a half an hour…….however long it takes to convince themselves they’ve mitigated the risk so they can go on with their day.

Lexapro, because it makes more serotonin available in the brain, can help ease OCD symptoms. It can reduce intrusive thoughts or at least reduce the power of them. In some instances, the intrusive thoughts may still pop up but the OCD sufferer will not take them as seriously and will be more apt to ignore them instead of engaging in their compulsions. Because ignoring OCD leads to fewer OCD cycles and, eventually, fewer intrusive thoughts, Lexapro can help relieve symptoms both directly and collaterally.

Why is Low Serotonin Linked to OCD?

While there’s no question that OCD is linked to lower serotonin levels, the question of why isn’t as clear and obvious. There is very much a chicken-or-the-egg argument as doctors don’t know if low serotonin causes OCD or if OCD causes low serotonin. But with Lexapro and other SSRIs, the order of operations, so to speak, isn’t important: Increasing serotonin leads to improvement in many sufferers regardless of why those low levels exist.

The reason for the OCD and serotonin connection might lie somewhere in genetics, where science has shown us that so many things tend to linger. In recent years, researchers have discovered four genes associated with OCD, including HTR2A, which is involved in the regulation of serotonin. Other genes include NRXN1, which plays an important role in synaptogenesis, synaptic maintenance, and neurotransmitter release; CTTNBP2, which is strongly linked to autism (which is also linked to OCD); and REEP3, which is believed to be important to synaptic plasticity.

The hSERT gene, the human serotonin transporter gene, is believed to play a role as well. It’s theorized that the gene might work faster in people with OCD, too fast in essence, enabling it to eat up extra serotonin and compromise communication between neurons.

Having mutations on these genes (or any other they discover) doesn’t guarantee that an individual will get OCD just as not having them doesn’t guarantee a life free of OCD. But a genetic disposition certainly makes it more likely to appear at some point. In fact, it’s believed that almost half of OCD cases (48%) are due to genetics. Other causes include childhood trauma, differences in brain structure, pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), autism, and pregnancy (as the influx in hormones may induce it). People with certain other mental health conditions are also at an increased risk, including those who suffer from anxiety disorders (such as social anxiety), depression, phobias, ADD, and substance use (alcohol and drugs may be used as ways to cope with OCD as well). Certain personality traits may make OCD more likely too, including perfectionism, indecisiveness, responsibility, neuroticism, and impulsivity.

Despite genetics, childhood, personality, co-occurring conditions, or anything else, OCD is an equal opportunity offender: It can happen to anyone.

What is Important to Know Before Starting Lexapro for OCD?

There are several key things to know before starting Lexapro for OCD (or any other reason). The following is a list of the most common questions and answers:

What is the prescribed dose?

For OCD, Lexapro is prescribed at doses up to 40 milligrams a day. This is higher than the dosages used for depression, which typically fall between 10-20 milligrams a day, and is on par with other antidepressants: OCD meds usually require higher doses in order to take effect. Doctors will often start you on a lower dose and gradually increase it.

How often should Lexapro be taken?

Lexapro needs to be taken every day regardless of how the sufferer feels. Some people make the mistake of using Lexapro in the same manner they would use Xanax or Valium, using it on an as-needed basis when they’re feeling stressed or anxious. But Lexapro is designed for everyday use; failing to take it in this manner risks interfering with serotonin levels and handcuffing the drug’s ability to work.

Does Lexapro interact with other medications?

Lexapro interacts with quite a few medications, which means there are many meds that don’t play nice when used together. For this reason, it should not be taken with prescriptions, over-the-counter medicines, or herbal supplements without speaking to a doctor or pharmacist first.

Specifically, Lexapro should not be combined with Orap (a medication used for Tourette’s), Celexa, or MAO inhibitors. Due to the risk of serotonin syndrome, a serious and potentially lethal condition that happens when too much serotonin is in the body, Lexapro should not be combined with the herbal supplement St. John’s Wort, the amino acid 5-HTP, Tramadol (an opiate-like painkiller), or any other drug or supplement that raises serotonin levels. People should use special caution with supplements that can be purchased online or at a local drugstore; many mood boosters increase serotonin levels to some degree.

Lexapro should not be combined with other SSRIs, either. It is also known to interact with certain stimulants, Parkinson’s medications, blood thinners, and migraine meds. Anyone who is concerned about whether they can take Lexapro with their current medications or herbs can use a drug interaction tool online to verify its safety.

Does Lexapro cause seizures?

Seizures are an uncommon side effect of SSRIs but a serious one, nonetheless. While seizures and antidepressants have been linked for quite some time, Lexapro doesn’t appear to significantly increase seizure risk, particularly in people without a history of seizure activity. Trazodone, lofepramine, and venlafaxine (Effexor) demonstrate the most significant risk.

What are the side effects of Lexapro?

Lexapro, like all drugs, is not immune to side effects. These tend to be limiting and self-resolving after several weeks but can occasionally be so intense for an individual that they stop taking the medication. Some of the most serious side effects reported with Lexapro include the following:

• Tunnel or blurred vision
• Seeing flashes of light or haloes
• Eye swelling or discomfort
• Risk-taking behavior that is out of character
• Racing thoughts
• Manic episodes
• Confusion
• Headache
• Vomiting
• Extreme weakness or fatigue
• Stiff and rigid muscles
• Lack of coordination
• Slurred speech
• Fever
• Extreme sweating
• Rapid heartbeat or palpitations
• Tremors
• Lightheadedness

Depending on what’s experienced, emergency medical intervention may be necessary, especially when the side effects could signal something more dangerous (such as a stroke).

Most side effects of Lexapro are not serious and better fit into the “inconvenient” category. The most common side effects reported include the following:

• Drowsiness
• Dizziness
• Weakness
• Sweating
• Shakiness
• Insomnia
• Reduced appetite
• Dry mouth
• Weight changes (both weight gain and weight loss have been reported)
• Constipation
• Upset stomach
• Yawning
• Sexual changes, including impotence, lack of libido, and inability to reach orgasm

People new to Lexapro should take caution when driving or operating machinery until they know how the drug will affect them.

How long does Lexapro take to work?

Some people may stop Lexapro too early, assuming that it isn’t working because they don’t feel any different. But it’s possible that they haven’t given it enough time to reach its full effects.

Lexapro is not a medication that offers immediate results; like most antidepressants, it takes about 4-6 weeks of consistent treatment before changes become noticeable. So, it’s important not to expect too much too soon; in other words, be a patient patient.

Does Lexapro increase suicide in adolescents and young adults?

Lexapro comes with a black box warning, which is the strongest warning administered by the Food and Drug Administration (FDA). In children, adolescents, and young adults specifically, Lexapro may increase suicidal ideation or behavior, most typically in the first few months of taking it or when the dose changes. Anyone noticing deviations in behavior in themselves or a loved one should consult with a doctor immediately.

Of course, Lexapro is not alone in this risk; a black box warning is required on several types of antidepressants. This is not without controversy, either; because black box warnings were established in 2004, nearly 20 years ago, and because some argue that they overinflate the risk of suicide and deter people away from antidepressants that could help them, many doctors believe it’s time to revisit these guidelines.

Is Lexapro prescribed to children?

Lexapro is generally only prescribed to individuals from the tween years and beyond. It’s not approved for children under the age of 12.

Lexapro and You

Whether or not Lexapro will work to help relieve your OCD symptoms depends; it doesn’t work for everyone but it does make a difference for many sufferers. Your genetic makeup determines how you metabolize medication, ultimately affecting whether Lexapro, or other drugs, can make an impact. You may benefit from knowing your status before trying a specific medication; you can learn this through companies like GeneSight, a company that tests the genetic efficiency of antidepressants. This process is usually covered by insurance, depending on your plan, and must be ordered by a physician.

Still, getting on the right medication, whether it’s Lexapro or something else, is only half the battle; there is unfortunately no magic pill that eliminates OCD and allows you to go on your merry, anxiety-free way. A combination of medication and exposure and response (ERP) therapy is considered to be the gold standard and leads to the most successful intervention. It’s a dynamic duo believed to be effective in at least 70% of OCD sufferers. Hopefully, you’ll be one of them!