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What You Need to Know About Antipsychotics and OCD

In the past, people with obsessive-compulsive disorder (OCD) were often given antipsychotic drugs to manage the anxiety and stress that often accompanies this condition. These older medications were not specifically designed to treat OCD, but they did help reduce some of the symptoms. Unfortunately, there are a lot of misconceptions about antipsychotics, and how they can be used to treat mental illness.

Because of this, many people feel uncomfortable when a doctor suggests using them as part of an extended treatment program. This is understandable. But before you refuse these medications, it is important to understand how antipsychotics work for people with OCD. In this article, we will go over everything you need to know about antipsychotics and OCD, so you can make an informed decision about your care plan moving forward.

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What is OCD?

Obsessive-compulsive disorder (OCD) is a common anxiety condition that involves non-stop, repetitive, and involuntary intrusive thoughts, urges, fears, doubts, mental images, negative emotions (obsessions), and/or ritualistic behaviors (compulsions). Some people struggle with just obsessions, while others grapple with just compulsions.

Most people, however, suffer from both obsessions and compulsions. Diagnosing and treating OCD can be challenging because there are different types of OCD, ranging from relationship OCD to meta-OCD. But, once a correct diagnosis is made, all types of OCD can be successfully treated.

OCD can be life-altering – and very lonely. It can affect your livelihood, relationships, employment, finances, and/or self-esteem and self-confidence. And, if left untreated it can cause can diminish your quality of life.

The good news is OCD can be effectively treated with therapy, medication, natural remedies, and self-help tools. When therapy alone does not work, this is called treatment-resistant OCD. When this occurs, a doctor will typically prescribe a medication, like an antipsychotic, to help combat your OCD symptoms. The key to OCD recovery is finding the right treatment for your particular type of OCD.

What Are Antipsychotics?

Antipsychotics are a class of drugs that affect the brain. Atypical antipsychotic medicines (such as olanzapine), are sometimes used to treat severe OCD, especially if the person is experiencing a loss of reality, paranoia, and/or psychosis. The goal of antipsychotics is to alter a person’s brain chemistry and boost serotonin levels in the brain.

Serotonin is a neurotransmitter that is often deficient in people with mental health conditions, such as OCD. Neurotransmitters are brain chemical messengers that transfer messages to various cells and organs in the body.

If these messages get interrupted, it can cause mental health issues, like obsessions and/or compulsions. Serotonin deficiency can lead to high levels of stress, anxiety, and/or depression. Serotonin is responsible for your mood, sleep, and overall behavior. Antipsychotics help increase serotonin in the brain, while reducing other neurotransmitters, like dopamine, in the brain, leading to fewer depressive and anxiety symptoms.

Dopamine is a “feel-good” neurotransmitter commonly associated with reward-driven behaviors. Dopamine is also one of the main neurotransmitters involved in OCD. People with OCD are thought to have higher levels of dopamine in certain areas of the brain, which can lead to compulsive thinking and behavior. Antipsychotics help reduce dopamine in the areas of the brain relevant to OCD, which in turn, may reduce some OCD-induced compulsive symptoms.

Norepinephrine is another neurotransmitter that helps regulate mood and stress. People with OCD are thought to have higher levels of norepinephrine in certain parts of the brain, which can lead to anxiety and difficulty sleeping. High levels of norepinephrine, another neurotransmitter, can also increase a person’s risk of developing OCD. Antipsychotics help reduce norepinephrine in the areas of the brain relevant to OCD, thereby reducing anxiety and insomnia.

What Conditions Can Be Treated with Antipsychotics?

Listed below are conditions that can be treated with antipsychotics:

  • Schizophrenia
  • Bipolar Disorder
  • Delirium
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive-Compulsive Disorder (OCD)
  • Generalized Anxiety Disorder (GAD)
  • Eating Disorders
  • ADHD
  • Parkinson’s Disease
  • Psychotic depression
  • Chronic Depression (Without Psychosis)

Are There Different Types of Antipsychotics?

Yes, there are different types – first-generation “typical” antipsychotics and second-generation “atypical” antipsychotics.

First-Generation Antipsychotics (older antipsychotics)

  • Haloperidol
  • Chlorpromazine
  • Fluphenazine
  • Perphenazine

Second-Generation Antipsychotics (newer antipsychotics)

  • Risperidone
  • Olanzapine
  • Aripiprazole
  • Lurasidone
  • Paliperidone

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Should You Try an Antipsychotic for OCD?

It depends.

Before you decide to try an antipsychotic for OCD, it is important to understand what these drugs are supposed to work for people with OCD. The goal of antipsychotics is to reduce the anxiety and obsessive thoughts associated with the condition, however, these drugs may not be well-suited for treating compulsions. Also, understand that antipsychotics, in general, are designed to be a long-term solution, so they must be taken indefinitely to remain effective.

However, if you decide to try an antipsychotic for OCD, the first thing you should do is talk to your doctor about the benefits and risks of using an antipsychotic for your type of OCD. Understand, however, that antipsychotics are not “magic pills” that will take away your symptoms overnight.

Keep in mind that it could take up to 4 weeks for the drug to kick-in, and make a noticeable difference. Although, you may notice mild changes in your OCD after a week or two. Still, it will probably take a couple of months before you see the full effects of the medication.

Are Antipsychotics Ever The First-Line Treatment for OCD?

Rarely.

The first-line treatment for OCD is usually SSRI depressants, medications that increase serotonin in the brain. SSRIs are the safest and most effective medication for OCD, which is why they are the “go-to” drugs for the condition. When SSRIs do not work, other medications, like antipsychotics are prescribed.

How Do Antipsychotics Treat OCD?

As we discussed above, antipsychotics can help reduce excessive levels of dopamine, and norepinephrine, and boost low levels of serotonin in the brain, which can reduce OCD symptoms. In some cases, OCD sufferers only need to use antipsychotics for a few months to get their symptoms under control. However, for some, an antipsychotic may be prescribed as a long-term treatment option.

Unfortunately, however, in some cases, antipsychotics are ineffective in the treatment of OCD. For antipsychotics to effectively treat OCD, they must be taken regularly at the prescribed dosage. If you abruptly stop using the medication, or if you skip doses, you may experience medication withdrawal symptoms and/or an OCD relapse.

Are Antipsychotics Effective for OCD?

Yes, studies suggest that antipsychotics can be effective for OCD, especially refractory OCD – at least short-term. Researchers suggest increasing the dosage or adding an SSRI if an antipsychotic does not appear to be working.

What Are the Side Effects of Antipsychotics?

Like with any medication, there are side effects associated with taking antipsychotics.

Weight Gain – The most common side effect is weight gain. This is common with antipsychotics. Antipsychotics can increase your appetite, and slow down your metabolism, which can, and often does lead to gradual weight gain over time.

Sleepiness – Some antipsychotics are known to cause significant drowsiness, which can make it hard to function during the day and increase your risk for accidents.

Dry mouth – Taking antipsychotics can cause your mouth to become extremely dry, which can make it difficult to eat and swallow.

Mood swings – Some antipsychotics are associated with mood swings. For instance, you may feel happy one minute and unhappy the next. You may also feel more irritable than usual. Understand, however, that these mood changes or mood swings may be long-term, persisting after you stop taking the medication.

Sexual side effects – Some antipsychotics are associated with sexual side effects, which can include erectile dysfunction, an inability to orgasm, premature ejaculation, performance anxiety, low libido, or a decreased interest in sex.

Other health conditions – Certain antipsychotics can increase your risk of developing other health conditions, especially metabolic conditions, like type 2 diabetes, hypotension (low blood pressure), digestive issues, blurry vision, restlessness, brain fog, poor motivation, uncontrollable movements, social withdrawal, and heart disease.

Can Antipsychotics Worsen OCD?

Yes, they can.

Because antipsychotics primarily block the release of dopamine in the brain, they can worsen OCD in some people.

What Are Some Common Antipsychotic Medications For OCD?

The most common antipsychotics for OCD are second-generation antipsychotics, such as:

How to Find the Right Antipsychotic for OCD

If you and your doctor decide that an antipsychotic is right for you, it is important to choose the right medication. There are several antipsychotics available that differ in how long it takes for them to kick in, how long they last, and how they make you feel.

If you are considering taking an antipsychotic for your OCD, talk with your doctor about the pros and cons, along with any potential side effects, of each antipsychotic. Knowing the side effects associated with each medication can help you make an informed decision about which one to try. Keep in mind that your doctor may suggest trying a few different antipsychotics to see which one works best for you and your symptoms.

Other OCD Treatments

OCD can be treated in a variety of ways, however, it is most commonly treated with therapy, specifically, cognitive-behavioral therapy (CBT) and exposure-response and prevention (ERP) therapy. ERP therapy is a type of CBT that involves changing how you see things, so your behavior also changes. Acceptance and commitment therapy (ACT), along with other therapies like hypnotherapy/hypnosis, grief counseling, addiction counseling, OCD group therapy, individual therapy, couples counseling, DBT, TMS, EDMR, and family therapy are also used to treat OCD.

When therapy alone is ineffective, medication may be prescribed in conjunction with the therapy. The most common therapy is ERP therapy, and the most common medication is SSRI antidepressants like Prozac, Paxil, and Zoloft. When therapy alone does not work, this is considered “treatment-resistant OCD.” And, when SSRIs are ineffective, a doctor may prescribe a different type of medication, like an antipsychotic, to help get your OCD symptoms under control.

Some OCD sufferers like to add natural remedies to their treatment plan to help enhance the medication and improve the overall outcome of the treatment. Natural remedies, holistic/alternative treatments, and self-help tools, like mindfulness meditation, CBD, crystals, OCD forums, books and workbooks, support groups, and podcasts, a healthy diet with plenty of vitamins, proper sleep, exercise, healthy coping skills and strategies, art therapy, music therapy, spending time with loved ones and friends, and investing in an online OCD program, like Impulse Therapy can make a world of difference during the treatment process.

The good news is there is a light at the end of the tunnel. With the right treatment – medication or not, you can make a full recovery from OCD. You no longer have to suffer in silence. Help is on the way.

Final Words

Antipsychotics are serious medications that require regular monitoring and medical supervision. The long-term use of these drugs can have serious health implications. As a result, they are not appropriate for everyone. Because of this, it is important that you talk with your doctor about the benefits and risks of these medications before making deciding to try them for your OCD.

While antipsychotics are not a “cure,” they may be a helpful treatment option for people with OCD. This is especially true for those, who struggle with anxiety or OCD symptoms so severe that they affect their ability to function during the day.

Remember, if you decide to try an antipsychotic, give the medication a chance to work. It may take a while for it to kick in. Also, understand that you may notice some side effects during this time.

References

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Author

DR. R. Y. Langham

Dr. R. Y. Langham has a B.A. in English, an M.M.F.T in Marriage and Family Therapy (Psychology), and a Ph.D. in Family Psychology. She is currently a medical, health & wellness contributor, copywriter, and psychological consultant

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