Are There New Medications For OCD?

Obsessive-compulsive disorder, or OCD, is a long-term mental health condition that manifests through obsessive thoughts and compulsive behaviors. 

The obsessive symptoms may include frequent intrusive thoughts or urges that cause emotional distress. Compulsions are repetitive behavior that one is driven to perform; if the patient resists the compulsion, they experience severe anxiety. 

Symptoms of OCD

OCD presents itself with two main symptom categories: obsessions and compulsions. Obsessions are frequent and intrusive thoughts or urge. Some common types of obsessions include: 

• Germ phobia, or fear of dirty and contaminated objects or surfaces

• Intense stress with disorganization

• Thoughts of unexpected danger

• Fear of causing harm to self or others through one’s negligence

• Unpleasant sexual thoughts

• Suicidal thoughts

People with OCD also experience compulsions, behaviors a person feels driven to perform. If they don’t complete the compulsion, severe anxiety results. 

Some common compulsions include:  

• Frequently finding yourself organizing objects in a particular manner 

• Excessive cleanliness, such as frequent hand washing, baths, or cleaning of surfaces

• Checking behaviors, such as constantly confirming that the door is locked or the stove is off

• Repeating phrases or actions to reduce anxiety, such as tapping your fingers

Are treatments available for OCD?

Treatment options help alleviate OCD symptoms, although they do not work for all individuals. Options include psychotherapy, medications, or a combination of both. 

Psychotherapy

The most commonly used form of psychotherapy for OCD¹ is a type of cognitive behavioral therapy (CBT) known as exposure and response prevention (ERP). CBT is a treatment in which the psychotherapist helps patients evaluate their thoughts and replace any negative patterns with new, healthier thought patterns. 

In ERP, the patient is gradually exposed to compulsion triggers (such as disorganized objects). The therapist helps them learn to resist the urge to perform the compulsive behavior. The intention is to gradually build tolerance and reduce the patient’s anxiety at not performing the behavior. 

Medications

Apart from psychotherapy, medications can also be used to treat OCD. Selective serotonin reuptake inhibitors² (SSRIs) are the first choice medication for treating OCD. 

The FDA has approved four SSRIs for treating OCD, including fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and paroxetine (Paxil). Two others, citalopram (Celexa) and escitalopram (Lexapro), are not FDA-approved for this specific disease but are commonly used anyway because research has shown that they’re effective.

SSRIs act by changing the levels of a brain chemical called serotonin. Although much research shows that SSRIs are effective for OCD, it’s still unclear exactly why they work. 

Some studies³ suggest that SSRIs activate certain brain networks usually suppressed in OCD patients. It helps reduce hyperawareness and anxiety and promotes healthier behavior patterns.

Clomipramine may be used for patients whose OCD doesn’t adequately respond to SSRIs. This is a different type of antidepressant known as a tricyclic antidepressant (TCA). It’s also FDA-approved for OCD, and research⁴ has shown that it’s just as effective as SSRIs. 

Alternative treatments for OCD

Although psychotherapy and medications are effective for many OCD patients, some people don’t get relief from these methods. Fortunately, other treatment methods can be used to treat OCD. 

Repetitive transcranial magnetic stimulation⁵ (rTMS) uses a strong magnet to stimulate brain cells in certain brain regions. Deep brain stimulation⁶ uses surgically implanted electrodes to change the activity of specific brain areas. 

Surgery can also remove particular parts of the brain to change activity patterns and reduce OCD symptoms. These options are only recommended in people who have already tried psychotherapy and medications and are still experiencing significant symptoms of OCD.

Adjunctive troriluzole as a treatment for OCD

Troriluzole⁷ (BHV-4157) is a new medication recently developed for OCD. It is modified riluzole, another drug approved by the FDA for amyotrophic lateral sclerosis. 

Scientists experienced a breakthrough after discovering that troriluzole could also serve as a treatment for OCD. Research⁷ results presented at the 2021 meeting of the American Psychiatric Association showed that troriluzole is effective for OCD when administered as adjunctive therapy. This means that troriluzole is effective when used with another form of treatment rather than as the sole treatment.

In 2020, pharmaceutical company Biohaven Pharmaceuticals, the maker of troriluzole, released the results of a study⁸ of the drug for OCD. It was found that 200 mg of troriluzole daily effectively reduced OCD symptoms.

Current clinical status

Although the research is promising, troriluzole is still being tested. This drug is currently in phase 3 clinical trials,⁹ which means studying how safe and effective a drug is using large population samples. 

If phase 3 trials show that a medication is effective, the FDA will consider approving the medication for use, allowing it to become widely available. Biohaven hopes that this will happen in the next few years. 

Treatment efficacy

Troriluzole changes the actions of a brain chemical called glutamate. Glutamate is an excitatory neurotransmitter produced by nerve cells in the brain whose function is to control learning and memory. Troriluzole may also affect the levels of serotonin produced by brain cells. 

Although some studies have shown that riluzole and troriluzole may be effective for OCD, it remains unclear exactly how they work. These drugs have several known mechanisms of action in the brain, and there may be other mechanisms we aren’t aware of yet. It’s not yet known what troriluzole does to help people with OCD.

Other medications being studied 

Besides troriluzole, scientists have been conducting studies on several new medications that can reduce OCD symptoms. Some medications and supplements also act on glutamate and have shown positive results in alleviating OCD symptoms. 

They include ketamine, rapastinel, memantine, a combination of N-acetylcysteine (NAC) and L-carnosine, lamotrigine, and topiramate. Over time, researchers will learn which medication options are the most effective.

Inflammation in the body is also believed to contribute to OCD symptoms, such as depression and anxiety. Therefore, researchers have tested whether immune-modulating and anti-inflammatory agents can help treat OCD. For instance, some studies on celecoxib, probiotics, and minocycline reveal they positively affect OCD symptoms.

Given the possibility of discovering new OCD medication, more studies should be conducted on these alternative treatments. 

Clinical trials

During a clinical trial, researchers test a new treatment or combination of treatments or compare one kind of treatment to another. 

Several new OCD medications are currently in clinical trials. This allows scientists to measure how well these drugs work and determine what the side effects are. A new medication must be safe and effective in several clinical trials before the FDA considers it for widespread use. 

Patients who have tried the standard treatment options and have not yet obtained relief may consider signing up for a clinical trial. This can give you access to a new medication that might benefit you. 

However, there are important tradeoffs to consider. There’s no guarantee that the new medication will be safe or work any better than the existing options.

Some people who enroll in a trial are given a placebo (an inactive “sugar pill”) for comparison. You will not have any control over which group you’ll be assigned (the new medication vs. placebo). 

If you want to consider the option of being part of a trial, discuss this with your treatment team.

The lowdown

Currently, the most commonly used treatment methods for OCD are SSRIs (a medication known as antidepressants) and psychotherapy. While many patients will benefit from these methods, they don’t work for everyone, and alternative treatment options are needed. 

Troriluzole is a new medication for OCD that has shown some promise. Several other new medication options are also being tested.

Frequently asked questions

Is OCD a treatable condition?

OCD can be very challenging, but there are effective treatments available. Most patients will experience at least some relief through the currently available treatments. While the symptoms will not completely disappear, they will often improve with treatment.

Do OCD medications offer 100% treatment for OCD?

Finding any treatment modality that works for 100% of patients is rare. About 70%¹⁰ of OCD patients benefit from medications, therapy, or a combination. For the rest, a few other treatment options can be tried.

Are there alternative herbal treatments that can serve as OCD medication?

Many people are interested in alternative medicine. There’s some research¹¹ into potential herbal therapies for OCD, but most studies have been very small and often poorly designed. 

Some herbal treatments, such as valerian root and myoinositol, have shown promising results. Still, more research is needed to determine whether herbal therapies are safe and effective for OCD.