A young woman is considering Lexapro for OCD.

Considering Lexapro for OCD? Read This

June 7, 2024

6 min.

Should you take Lexapro for OCD? Read on to learn what a psychiatrist and team of psychiatric nurse practitioners think you should know about using this antidepressant as an OCD treatment.

By: Dr. Eli Muhrer, M.D.


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Considering Lexapro for OCD? Read This

June 7, 2024

6 min.

Should you take Lexapro for OCD? Read on to learn what a psychiatrist and team of psychiatric nurse practitioners think you should know about using this antidepressant as an OCD treatment.

By: Dr. Eli Muhrer, M.D.

Table of Contents

Table of Contents

If you struggle with obsessive-compulsive disorder (OCD), the symptoms can majorly interfere with your overall well-being, functioning, and quality of life. Obsessions can be extremely distressing, and compulsions performed to reduce distress ultimately fuel the OCD to keep going. 

Psychiatric medications are a common aspect of OCD treatment, helping to reduce obsessive thoughts and compulsive behaviors. Lexapro (the brand name for escitalopram) is one example of a selective serotonin reuptake inhibitor (SSRI) antidepressant that doctors may prescribe for OCD in certain cases. Here’s what you need to know about taking Lexapro for OCD, including how effective it is, its side effects, how long it takes to work, and alternative treatment options. 

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Is Lexapro used as a treatment for OCD?

It’s important to note that Lexapro is not FDA-approved for the treatment of OCD. However, mental health professionals may still prescribe it to help people with OCD. “Lexapro is sometimes used off-label to treat associated symptoms of OCD, as it can be very effective in the management of anxiety disorders and thus reduce symptoms of anxiety in OCD,” says Charlie Health Psychiatric Mental Health Nurse Practitioner Rebecca Holland, PMHNP-BC.

The medication’s only FDA-approved indications are the treatment of generalized anxiety disorder (GAD) and major depressive disorder (MDD). However, Holland notes that patients may find Lexapro to help reduce OCD symptoms such as rumination and intrusive thoughts. Not having FDA approval for OCD does not mean it is not helpful for it like other SSRIs that have FDA approval for it. FDA approval is a specific process drug companies go through to get an “on-label” indication for their medications. Due to the expense and time involved in this process, many drug companies do not seek FDA approval for every use of their medications.

Holland says that OCD commonly co-occurs with other mental health conditions, including anxiety disorders and depression. It’s estimated that around 76% of people with OCD also have an anxiety disorder, and 41% have depression. In these cases, Lexapro can help to relieve the symptoms related to those disorders, improving overall well-being. 

So, in essence, yes, you can take Lexapro off-label for OCD if your prescriber thinks that this drug is the best fit for you –– but this is not an FDA-approved use. 

Is Lexapro effective for OCD symptoms?

There isn’t a lot of research surrounding how effective Lexapro is for OCD symptoms. However, given the data that we do have, it does appear that Lexapro (escitalopram) can help people with OCD. 

For example, one study found that escitalopram was effective at relieving OCD symptoms and improving functioning. Additionally, the study found that escitalopram is better tolerated, meaning it resulted in less disruptive side effects, than Paxil (paroxetine), an SSRI that is FDA-approved for OCD treatment. Further research showed that escitalopram can also prevent relapse of OCD symptoms. Another study found that high doses of escitalopram –– higher than what the FDA recommends –– are especially helpful for relieving OCD symptoms. 

What are the side effects and risks of Lexapro?

When you take any medication, there is a risk of side effects. The most common side effects of Lexapro include: 

  • Tiredness
  • Nausea
  • Dizziness
  • Trouble sleeping
  • Dry mouth
  • Changes to sexual desire/sexual dysfunction
  • Anxiety
  • Increased sweating
  • Shaking
  • Loss of appetite
  • Constipation

There are also some serious risks to consider, including serotonin syndrome. Taking any SSRI poses the risk of serotonin syndrome, a condition when you have dangerously high levels of serotonin. The symptoms can range from mild to severe and life-threatening. More mild symptoms include dilated pupils, fast heart rate, excess sweating, and diarrhea. Some red flags for severe serotonin syndrome include fever, tremors, seizures, and unconsciousness. If you have any potential signs of serotonin syndrome, even if mild, make sure to tell your doctor. Your risk of this complication is higher if you take other medications that impact serotonin. 

Also, Lexapro comes with a “black box warning” that you might experience worsening depression symptoms, new or worsening suicidal thoughts, and changes in behavior –– especially when you first start the medication. This risk is higher if you’re under 24 years old. This isn’t an extensive list of side effects or serious risks, so make sure to discuss safety concerns with your provider before you start any medication.  

Common Lexapro side effects

Serious less-common Lexapro side effects

Tiredness, nausea, dizziness, trouble sleeping, dry mouth, changes to sexual desire/sexual dysfunction, anxiety, increased sweating, shaking, loss of appetite, constipation

  • Serotonin syndrome: A condition when you have dangerously high levels of serotonin, with symptoms ranging from mild (dilated pupils, fast heart rate, sweating, diarrhea) to severe (fever, tremors, seizures, unconsciousness), especially if combined with other serotonin-impacting medications.
  • Black box warning: Lexapro carries a “black box warning” for potential worsening depression, suicidal thoughts, and behavior changes, particularly in individuals under 24 years old.

How long does it take for Lexapro to work?

SSRIs like Lexapro don’t start working immediately. Typically, you’ll start at a low dose and slowly increase the dose over the course of several weeks. “It can take up to six to eight weeks to see the full benefit from each dose of Lexapro,” says Claire Streeter, PMHNP, ARNP, a Psychiatric Mental Health Nurse Practitioner with Charlie Health. 

So, be patient if you’re starting Lexapro and understand that you won’t experience symptom relief right away. It takes time to reach a therapeutic dose and for your body to adjust to the medication. However, if it’s been more than six to eight weeks and you don’t feel any difference, be sure to tell your provider so they can re-evaluate the treatment plan, which may include increasing the dose or considering an alternative medication. 

Additionally, you should always take the medication exactly as directed and never decrease the dose or stop taking it without explicit instruction from your provider. Coming off Lexapro, especially abruptly, can lead to discontinuation syndrome and withdrawal symptoms.

What are other treatments for OCD?

If Lexapro isn’t the right fit for you, there are many other medications you can take. Not to mention, therapy is also a large component of OCD treatment.

Medications for OCD

The main medical treatment for OCD is using an antidepressant. As mentioned, SSRIs are a common first-line treatment for OCD. SSRIs that are FDA-approved for OCD treatment are:

  • Luvox (generic: fluvoxamine)
  • Paxil (generic: paroxetine)
  • Prozac (generic: fluoxetine)
  • Zoloft (generic: sertraline)

Additionally, the tricyclic antidepressant (TCA) Anafranil, the brand name for clomipramine, is an FDA-approved OCD medication. Holland says this is generally not a first-line choice since TCAs typically have more side effects than SSRIs. However, in people who haven’t responded to SSRIs, clomipramine can be effective, she adds. 

Therapy for OCD 

A combination of medication and therapy is generally the most effective for treating OCD symptoms. Holland says that psychotherapy is essential in managing OCD. Therapy can help you learn invaluable tools that allow you to cope with obsessions and compulsions. Three types of therapy commonly used for OCD are as follows: 

Exposure and response prevention (ERP)

ERP is often called the “gold standard” of OCD therapy due to how effective it is. In ERP, your therapist will help you gradually expose yourself to thoughts or situations that trigger your obsessions. Then, you resist performing the compulsion that you usually engage in to reduce your anxiety. With time, this helps you become more desensitized to these fears and decreases your urge to perform compulsions. 

Cognitive behavioral therapy (CBT)

CBT helps you identify negative, unhealthy thought patterns and create healthier new ones. You’ll learn how your thoughts, feelings, and behaviors are all connected, as well as coping skills to manage anxiety and other difficult emotions. 

Acceptance and commitment therapy (ACT)

ACT is a unique type of therapy that urges you to practice acceptance rather than fighting against or avoiding difficult emotions or thoughts. You will learn to tolerate OCD symptoms as a part of the human experience and learn to mindfully detach from your thoughts. 

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OCD treatment and medication management at Charlie Health

If you or a loved one are struggling with OCD, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for young people and families dealing with serious mental health conditions, including severe OCD and co-occurring conditions like generalized anxiety disorder and major depressive disorder. 

Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. We also offer medication management to clients as needed for those who could benefit from psychiatric medications on top of therapy. With this kind of holistic treatment, OCD recovery is possible. Fill out the form below or give us a call to start healing today.

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