Is Zoloft (sertraline) an effective treatment for OCD?

Therapy and medication. These two approaches are the first-line treatments for a range of mental disorders, meaning that they are the solutions most often recommended by clinicians. Sometimes these treatments are used on their own, while other times they’re used in concert with one another—a sort of one-two punch that can often reduce symptoms’ intensity, frequency, or duration. 

Obsessive-Compulsive Disorder (OCD) is one of the many conditions that has been proven to be effectively treated by therapy and/or medications, based on decades of research. One of the medications commonly prescribed for this purpose is Zoloft, also known by its generic name, sertraline.  

Let’s take a few minutes to learn what Zoloft is and how it treats OCD symptoms, while discussing other things to keep in mind when considering Zoloft for OCD. Armed with this information, you can make better decisions about how best to regain control of your life from OCD.

Obsessive-Compulsive Disorder (OCD) explained

Often mistaken for a relatively benign preoccupation with cleanliness or order, OCD is characterized by a cycle of obsessions and compulsions that significantly impact a person’s daily life. It affects between 1-2% of the global population and, in some cases, can render people housebound, put them at a higher risk of developing other mental disorders, and even suicide. 

As the name suggests, OCD’s core components are obsessions and compulsions. When we talk about obsessions in the context of 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, causing significant distress that feels impossible to ignore. They become obsessions, and they often directly contradict the sufferer’s core values and beliefs.

To reduce that distress, people with OCD engage behaviors known as compulsions. Compulsions may manifest physically or mentally: repeated actions, repeated phrases, avoidance of specific situations, constant reassurance-seeking from friends or family, or excessive research to validate or refute the validity of obsessions. But whatever form compulsions take, they intend to reduce the discomfort ego-dystonic obsessions cause. However, the relief they provide is always fleeting, and comes at the cost of strengthening and perpetuating the “OCD cycle,” taking up time, causing distress, damaging close relationships, and removing people from the driver’s seat of their lives. 

What is Zoloft (sertraline) 

Zoloft belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs), along with Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine),  Luvox (fluvoxamine), and Paxil (paroxetine). Though serotonin and norepinephrine reuptake inhibitors (SNRIs) and a tricyclic antidepressant (TCA) called clomipramine are also sometimes used to treat OCD symptoms, SSRIs are the most common medications prescribed for this purpose.   

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

Zoloft and OCD

Numerous research studies have demonstrated the efficacy of Zoloft in reducing OCD symptoms. It can help alleviate obsessions, compulsions, and related anxiety, allowing people to regain control over their thoughts and behaviors. It’s estimated that anywhere between 40 and 60% of people with OCD may experience a positive response to SSRI treatment, including Zoloft. 

You may wonder why people undergo potentially uncomfortable ERP sessions when an affordable, generic pill can effectively control OCD’s symptoms. One important consideration is the time required for medications like Zoloft to work.

“When you take Zoloft for anxiety or depression, it tends to work for most people within two to four weeks,” says Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD. “With OCD, it usually takes anywhere from about six weeks to about 12 weeks to start working, and, in some cases, things continue to improve for many weeks or even months after that. Needless to say, this requires a lot of patience. There’s also a chance that Zoloft might not work sufficiently, or at all for an individual, but we really have to wait for at least 12 weeks to make that assessment. At that point, a provider might prescribe another type of SSRI or something else entirely.”

To put that in context, 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 Zoloft for OCD and other mental disorders is in the dosages that are typically used.

Zoloft’s dosage, side effects, and other considerations

“Usually, higher doses of Zoloft are used for OCD compared to GAD or depression,” explains Dr. Feusner. “In fact, at higher doses, it practically becomes a different drug ,because it works on an entirely different area of the brain.”  

Exactly how much bigger are those doses? Feusner says that a daily 200mg dose of Zoloft is typical among OCD patients, whereas 75 or 100mg is a typical dose for people with depression. He adds that doses of 300mg or even higher may be necessary to see an optimal reduction in symptoms in some OCD patients. Although outside the FDA-recommended range, there is a lot of clinical experience that doses this high can be safe, tolerated, and effective for people with OCD.

Another thing people need to consider when taking Zoloft is the side effects it’s associated with—side effects that people may experience whether the drug reduces their OCD symptoms or not. Many of these are mild to moderate and tend to disappear within a few weeks. That said, other side effects can persist longer. Some of Zoloft’s more common side effects include: 

• dry mouth
• insomnia
• reduced sex drive
• nausea
• dizziness
• fatigue
• diarrhea
• constipation
• 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. Dr. Feusner adds that just because a person with OCD is taking two or three times the dose of someone using Zoloft for depression or anxiety, the side effects aren’t typically two or three times more severe. 

The relationship between medication and therapy for OCD treatment

The biggest difference medications have with the other first-line OCD treatment is that drugs treat the symptoms of the condition while ERP can result in more long-lasting benefits that continue well beyond the episode of treatment. What that means is that stopping taking medication used to treat OCD symptoms will result in those symptoms showing up once again. But if Zoloft’s side effects are non-noticeable or easily managed, this treatment may end up being a long-term option to keep OCD symptoms at bay, as it has been for many. 

Often, however, medication like Zoloft is used as a means of making ERP more tolerable—or even possible—for some people, and the two forms of treatment complement each other. 

SSRIs like Zoloft 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. Secondly, some (but not all) 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 demonstrates that adding ERP is very effective in further reducing OCD symptoms.

Access the right treatment options for you

While not always necessary for a full recovery, medications like Zoloft can be an effective treatment option for individuals living with OCD. They’ve been shown to reduce obsessions, compulsions, and related anxiety, allowing people to regain control over their lives. For some, the most effective treatment plans could involve a combination of ERP and medication to reduce symptoms. 

NOCD therapists are specially trained in delivering ERP and regularly refer members to qualified prescribers who can identify medication that may reduce their 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 a loved one overcome OCD.