Examining The Use Of Lexapro In The Treatment Of OCD

Lexapro is an antidepressant belonging to the class of medicines known as selective serotonin reuptake inhibitors (SSRIs). Lexapro works by regulating serotonin levels in the brain. It is available as 5 mg, 10 mg, or 20 mg tablets, as well as liquid drops. The generic name for Lexapro is escitalopram.

Doctors typically prescribe Lexapro to treat anxiety and depression, especially anxiety and depression associated with generalized anxiety disorder (GAD) and major depressive disorder (MDD). Physicians can, in some situations, prescribe Lexapro to treat obsessive-compulsive disorder (OCD).

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a mental illness characterized by recurrent unpleasant thoughts or feelings (obsessions) or a strong need to repeat a behavior (compulsions). Many people with OCD are aware that their thoughts or actions are irrational.

However, they engage in these recurrent and repetitive behaviors not because they enjoy it but because they cannot stop.

Some examples of obsessive thoughts are worrying about people getting hurt or being constantly aware of your breathing, blinking rate, or other physical sensations. Examples of compulsive habits include:

• Performing tasks in a certain order

• Needing to count items such as bottles or steps

• Being afraid of shaking hands, using public restrooms, touching doorknobs, etc.

Not all routines or habits are compulsions. Everyone double-checks things once in a while. However, people with OCD cannot control their thoughts or behaviors, and they will spend at least an hour a day on these obsessions or compulsions.

While people with OCD do not enjoy their compulsive habits or rituals, doing them may temporarily relieve the anxiety generated by their obsessive thoughts.

Is Lexapro used as a treatment for OCD?

Few studies¹ have assessed the use of escitalopram (Lexapro) for OCD; however, studies² have found that escitalopram has good efficacy in treating several OCD symptoms.  Several indicators show that escitalopram has significant potential in treating OCD in adults. 

These indicators include:

• Lexapro is an SSRI, similar to other medicines used as first-line therapy for OCD

• Among the SSRIs, escitalopram is the most selective 5HT reuptake inhibitor

• Escitalopram has been proven effective in treating other anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder

• Escitalopram³ was found to be superior to placebo in one double-blind, placebo-controlled trial of escitalopram in OCD

A study⁴ was done to determine the efficacy and tolerability of escitalopram in obsessive-compulsive disorder (OCD), using paroxetine — another SSRI, as a reference. 

The study showed that escitalopram, 20 mg/day, was linked with improved functioning, higher response and remission rates, and better tolerability than paroxetine. Escitalopram should, therefore, be regarded as one of the first-line medications in the long-term treatment of OCD.

Lexapro dosage in the treatment of OCD

The dosage of Lexapro for OCD varies depending on the patient's symptoms, medical history, and sensitivity to adverse effects. 

According to a 2014 study,⁵ SSRIs are more successful in treating OCD in high doses, often higher than the doses used to treat the major depressive disorder (MDD). According to the study, a 40 mg dose of escitalopram⁶ is commonly required to treat OCD symptoms. 

A 40 mg dose for OCD differs from other disorders, as escitalopram is prescribed in doses ranging from 10 to 20 mg daily to treat depression and anxiety. The same study discovered that OCD patients on Lexapro — or another SSRI — take longer to respond to the medication and require more treatment time. 

Talking to your doctor before taking Lexapro for OCD is crucial because the FDA does not specify a precise Lexapro dosage for OCD.

What are the side effects of Lexapro?

The effects of Lexapro, like any other medication, will vary from person to person. The most common adverse effects of Lexapro include:

• Nausea

• Fatigue

• Diarrhea

• Headache

• Constipation

• Drowsiness

• Dry mouth

• Increased sweating

• Restlessness

• Insomnia

These side effects will often improve over the first week or two as you continue to take the medication. Contact your doctor if the symptoms persist or worsen.

In rare circumstances, Lexapro has been known to cause serious side effects, such as:

• Low levels of sodium in the blood

• The onset of manic episodes

• Changes in appetite 

• Unexplained weight gain

• Vision problems

• An increase in suicidal thoughts or actions

• Violent behavior

• New or worsening depression, anxiety, or panic attacks

There is always the possibility of side effects with any drug. However, Lexapro is a safe and effective medication when taken as directed. 

How long does Lexapro take to work for OCD?

The physiological effects of Lexapro start almost immediately, and many people notice a difference quickly. Even though the drug starts to work from the first day it is taken, different people will experience the effects at different periods.

Most people say they start to feel the effects of their medication after four to eight weeks of taking it consistently.

Conditions to discuss with your health care provider before taking Lexapro

Before you start taking Lexapro, there are a few things you need to talk to your doctor about. First, inform them if you are allergic to escitalopram, citalopram, or other medications. Other conditions you should discuss include:

• Other medications you are currently taking

• Whether you are breastfeeding, pregnant, or plan to get pregnant

• If you drink alcohol or use drugs

• Whether you have suicidal thoughts

It's important to ensure your doctor knows whether you have any medical issues, such as liver disease. The liver is principally responsible for the metabolism of selective serotonin reuptake inhibitors (SSRIs), so patients with liver disease may have difficulties metabolizing Lexapro. 

The lowdown

Even though escitalopram appears to be effective in various anxiety disorders, little research has been done on its efficacy in OCD. However, several case studies imply that escitalopram may be beneficial for disorders with obsessive features or conditions linked to OCD. More clinical studies need to be done to confirm the role of escitalopram in the treatment of OCD.