Everything you need to know about using Prozac (fluoxetine) for OCD

While no one can say how long Obsessive-Compulsive Disorder (OCD) has shown up in people, it was first described as a separate condition in 1877 by German psychiatrist Carl Westphal. In the following decades, psychologists, psychiatrists, neurologists, and other mental health care experts worked to find an effective treatment to address this serious and often debilitating mental disorder. Towards the end of the 20th century, they found two approaches considered “first-line” treatments—the primary recommended course of action for people diagnosed with a specific medical condition.

The first of those first-line treatments was developed in the 1970s to treat OCD. It’s called exposure and response prevention therapy (ERP). It involves a trained therapist gradually exposing people with OCD to their fears or triggers while refraining from engaging in their usual compulsive behaviors. This process helps people desensitize to the emotions associated with the triggers, often realize their fears are unfounded, and enables them to tolerate their doubts. In most cases, ERP effectively reduces OCD symptoms over time, often within a matter of weeks.

The other first-line treatment for OCD is a handful of medications that have shown efficacy in reducing the severity of OCD symptoms—often used in tandem with ERP therapy. One of the medications for this purpose is fluoxetine, a selective serotonin reuptake inhibitor (SSRI) commonly known by its brand name Prozac.

Today, we’ll discover what Prozac is, its applications in treating OCD symptoms, and certain things that distinguish it from other common medications used in OCD treatment. We hope you can use these facts to make informed decisions on your journey to regain control of your life.

Unpacking Obsessive-Compulsive Disorder (OCD)

Before delving into the potential benefits of Prozac and other medications used to treat OCD, let us take a moment to grasp the nature of this disorder. Often mistaken for a relatively benign preoccupation with cleanliness or order, in reality, OCD is characterized by a cycle of obsessions and compulsions that significantly impact a person’s daily life: the vicious cycle of OCD can limit people’s ability to socialize, be productive at work, or even leave home. 

When we talk about obsessions in OCD, we’re referring to intrusive thoughts, images, or urges that cause anxiety and distress. While almost everyone experiences random intrusive thoughts, for people with OCD these thoughts tend to persist and become more distressing. This distress leads people to engage with these thoughts, mistakenly attributing meaning to them and feeling unable to let them go. These obsessions are most often ego-dystonic, directly contradicting the person’s core values and beliefs.

To alleviate the distress and anxiety caused by these obsessions, people with OCD engage in a range of behaviors known as compulsions. Compulsions can show up as, for example, repetitive physical or mental actions, repeated phrases, avoidance of specific situations, constant reassurance-seeking from friends or family, or excessive research to validate or refute the validity of their obsessions. Regardless of their form, compulsions aim to reduce the overwhelming feelings of anxiety or dread caused by obsessions. However, the relief they provide is temporary and only perpetuates the OCD cycle, reinforcing the notion that obsessions pose a real threat or have any meaning.

Prozac (fluoxetine) in a nutshell

Prozac belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs), including other medications like Celexa (citalopram), Lexapro (escitalopram), Zoloft (sertraline), Luvox (fluvoxamine), and Paxil (paroxetine). While serotonin and norepinephrine reuptake inhibitors (SNRIs) and the tricyclic antidepressant clomipramine are sometimes also used for OCD symptoms, SSRIs are the most commonly prescribed type of medications.

The immediate effect of SSRIs is to increase the amount of serotonin between nerve cells in certain parts of the brain. However, there is no conclusive evidence of a serotonin deficiency in people with OCD, so the benefits of SSRIs in OCD treatment aren’t thought to be a result of this immediate effect. Rather, they most likely work as a tool to alleviate OCD symptoms through gradual changes that occur over time in response to these increased serotonin levels.    SSRIs are also used to treat depression, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD)—conditions frequently accompanying OCD—although the main mechanisms of action believed to alleviate symptoms of these disorders differ.

Prozac’s Use in OCD Treatment

Numerous research studies attest to Prozac’s effectiveness in reducing OCD symptoms. It aids in alleviating obsessions, compulsions, and related anxiety, empowering people to regain control over their thoughts and behaviors. Around 40-60% of people with OCD may experience positive responses to SSRI treatment, including Prozac.

According to Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD, Prozac for anxiety and depression typically works for most people within two to four weeks. However, for OCD, it usually takes about six to twelve weeks to start working. And sometimes, improvements continue for several weeks or months beyond that initial period. 

“Patience is crucial when using SSRIs like Prozac,” he explains. “It should also be noted that there’s a significant possibility that Prozac may not work sufficiently, or at all for an individual. It’s essential to wait at least twelve weeks to evaluate its effectiveness. At that point, a healthcare provider might consider prescribing a different SSRI or exploring other treatment options altogether.”

ERP—the other first-line treatment for OCD—often leads to a significant reduction in OCD symptoms within twelve to twenty weeks of treatment for most people. Another distinguishing factor between using Prozac for OCD and other mental disorders is the dosages used.

“In treating OCD, higher doses of Prozac are typically used compared to GAD or depression,” explains Dr. Feusner. “At these higher doses, it effectively becomes a different drug, activating a distinct part of the brain.” So, how much higher are these doses? Dr. Feusner mentions that a daily dose of 60 or 80mg is common for OCD patients, while a typical dose for people with depression is 20mg or sometimes 40 mg. Doses of 100mg or even 120 mg may be necessary to achieve optimal symptom reduction in some patients with OCD. Although outside the FDA-recommended range, there is a lot of clinical experience that doses this high can be safe, tolerated, and effective for some people.

When considering Prozac, it’s also important to be aware of potential side effects associated with it. While many of these side effects are mild to moderate and tend to dissipate within a few weeks, some can persist for longer. 

Common side effects of Prozac include dry mouth, insomnia, reduced sex drive, nausea, dizziness, fatigue, diarrhea, constipation, and decreased appetite.

As is the case with all psychiatric medications, they should be carefully chosen for each individual and monitored by the prescriber, particularly in the first few weeks, to ensure that more serious side effects do not occur.

When compared to Zoloft (sertraline) and Lexapro (escitalopram), Prozac is less likely to result in nausea, dry mouth, headache, blurred vision, memory impairment, tinnitus, light-headedness, erectile dysfunction, anorgasmia, decreased libido, poor satisfaction with sexual life, insomnia, abnormal dreams, constipation, and diarrhea. However, it’s more likely to result in delayed ejaculation. 

Remember that everyone’s response to medication varies, and side effects can vary significantly from person to person. Some people may experience side effects with one SSRI but tolerate another SSRI better. What this boils down to is a certain amount of trial and error being involved in is finding the right medication for you. 

Dr. Feusner adds that despite people with OCD taking higher doses of Prozac than those using it for depression or anxiety, the side effects are not necessarily two or three times more severe. It’s also crucial to consider that side effects and medication recommendations may depend heavily on a wide range of pre-existing conditions. 

The relationship between Prozac and ERP therapy

The most significant difference between medication and ERP, the other first-line treatment for OCD, lies in their approach to the condition. While medication focuses on symptom management, ERP can result in more long lasting benefits that continue beyond the episode of treatment. That means that discontinuing medication used for OCD symptom treatment may result in the re-emergence of those symptoms. However, if Prozac works at reducing symptoms and its side effects are manageable or don’t show up at all, continuing medication may serve as a long-term solution for OCD symptoms, as it has for many people.

However, it’s very common for medications like Prozac to be used alongside ERP, especially for those with more severe OCD symptoms. These medications can help reduce anxiety and other distress associated with OCD, as well as the severity of obsessions and urges to do compulsions. This could provide an additive effect with ERP of reducing OCD symptoms. Some (but not all)  with more severe symptoms might find it helpful to have at least a slight reduction in severity of obsessions, urges to do compulsions, and distress, in order to start difficult exposure exercises and resist certain compulsions.

Importantly, when someone is taking an SSRI for OCD but there is not a sufficient response, research has shown that adding ERP can be very effective in further reducing OCD symptoms.

While medication isn’t always necessary for a complete recovery from OCD, it can be a valuable treatment option. It has demonstrated its ability to reduce obsessions, compulsions, and associated anxiety, enabling people to regain control over their lives. Comprehensive treatment plans often involve a combination of ERP and medication to alleviate symptoms. 

NOCD therapists, who are specialty-trained in delivering ERP, regularly refer patients to qualified prescribers who can identify suitable medications to reduce OCD symptoms and/or the symptoms of other commonly co-occurring disorders such as depressive disorders and anxiety disorders. Schedule a free call today with the NOCD Care Team to learn more about how a licensed therapist can help you or your loved one overcome OCD.

Evidence-based treatment can lead to long-term recovery

Various research studies have demonstrated Prozac’s efficacy in reducing obsessions, compulsions, and anxiety. However, it’s important to consider the time it takes for the medication to work and the potential side effects associated with its use. 

While medication alone may provide relief, a combination of exposure and response prevention therapy (ERP) and medication can yield the best outcomes in some. The decision to pursue medication for OCD should be made in consultation with a licensed healthcare professional who can assess individual circumstances and provide personalized guidance. With the right approach and support, people living with OCD can take significant steps toward regaining control over their lives.