When people hear “OCD treatment,” they often think of therapy only. In reality, obsessive-compulsive disorder is a very medication-responsive condition, as long as dosing, duration, and follow-up are done properly.
Across Advanced Psychiatry Associates offices in California, we use a stepwise, psychiatry-led approach to OCD medication treatment: starting with high-dose SSRIs, considering clomipramine or SNRIs in specific cases, and using antipsychotic augmentation when needed. At the same time, we coordinate with therapists providing ERP (Exposure and Response Prevention) without turning this into a therapy lesson.
This guide is here to set expectations so OCD treatment feels less mysterious and more like a clear medical plan.
Why OCD medication treatment looks different from depression treatment
The first surprise for many patients: the doses and timelines for OCD are more aggressive than for depression or generalized anxiety.
For depression, an SSRI might be considered “optimized” at a moderate dose. For OCD, guidelines and clinical practice often require:
Higher doses, frequently at or near the top of the FDA-approved range
Longer trials, 10–12 weeks at target dose, not just “I tried it for a month.”
So if you’ve “tried an SSRI” at a low dose for a few weeks and it didn’t touch your obsessions or compulsions, that doesn’t really count as a full OCD trial.
At APA, we manage this through structured Medication Management visits with clear titration plans and side-effect monitoring, not “take this and hope for the best.”
SSRIs and sometimes SNRIs at OCD-level doses
For most adults, first-line OCD pharmacology starts with an SSRI:
Sertraline
Fluoxetine
Fluvoxamine
Paroxetine
Escitalopram / citalopram
And in some cases, SNRIs (like venlafaxine) are considered when SSRIs are ineffective or poorly tolerated.
What to expect with SSRIs for OCD
Titration: we start low to avoid side effects, then gradually increase to an OCD-effective dose.
Target dose: often higher than what you’ve seen for depression; this is expected, not reckless.
Timeline: meaningful OCD improvements typically emerge after 8–12 weeks at a therapeutic dose, not just 2–3 weeks.
Side effects: nausea, GI upset, sexual side effects, insomnia/sedation, mild weight changes. Most are manageable with slow titration, dose timing, or switching agents.
We monitor:
Blood pressure and heart rate when indicated
Drug interactions (other meds, supplements)
Sleep and appetite changes
Suicidal thoughts, especially early in treatment
Our OCD care is anchored in the OCD service line, and runs through structured Medication Management, not casual refills.
Clomipramine: powerful but higher-maintenance
If multiple SSRIs have failed at adequate dose/duration, or if there’s a strong historical response, we may consider clomipramine, a tricyclic antidepressant (TCA) with very strong anti-OCD evidence.
Pros of Clomipramine as an OCD Treatment
One of the most effective pharmacologic options for OCD
Can work in both obsessional thinking and compulsive behaviors
Why is Clomipramine not the first OCD treatment line
More side effects: dry mouth, constipation, dizziness, weight gain, sexual side effects
Cardiac considerations: TCAs can affect heart rhythm; we often obtain an ECG, especially in older patients or those with cardiac history.
Overdose toxicity: safer when dispensed with monitoring and clear instructions
Interaction potential: with other serotonergic meds and certain medical drugs
Clozapine gets the “intense” reputation in psychosis; clomipramine is the OCD version of “this is serious business,” and we treat it with the same level of lab and ECG respect.
Antipsychotic augmentation: when an SSRI isn’t enough
Sometimes an SSRI alone takes you from “this is unbearable” to “this is better, but still controlling my day.” That’s the zone where augmentation makes sense.
Small doses of certain second-generation antipsychotics, often risperidone, aripiprazole, or similar agents, can be added to a stable SSRI to target residual intrusive thoughts and compulsive urges.
What augmentation looks like
We keep your SSRI dose stable.
Add a low-dose atypical antipsychotic, carefully titrated.
Monitor for:
Weight and metabolic changes (glucose, lipids)
Extrapyramidal symptoms (stiffness, restlessness, tremor)
Prolactin-related issues, depending on the medication
These are not “forever” medications for everyone; some patients maintain long-term, others use them as a bridge to better control while ERP skills are being built with a therapist.
Where ERP fits without turning this into a therapy article
Exposure and Response Prevention ERP is the gold-standard therapy for OCD. It trains how your brain relates to intrusive thoughts and compulsive urges.
Our stance, in one sentence:
Medications lower the volume of intrusive noise; ERP teaches your brain not to keep turning the dial back up.
At APA:
We do not provide ERP ourselves during medication visits.
We do coordinate with therapists (internal or external) who specialize in ERP.
We use meds to:
Reduce symptom intensity so ERP is actually tolerable
Stabilize co-occurring depression or anxiety that’s blocking ERP work
The goal is psychiatry-led pharmacology with ERP-informed timing, not “meds or therapy, pick one.”
For a broader anxiety context, patients can also explore our Anxiety service page.
OCD medication care at APA across California
If you’re dealing with OCD in California and you’re ready for a proper medication plan, here’s what care usually involves at Advanced Psychiatry Associates:
Thorough psychiatric evaluation of obsessions, compulsions, insight level, and co-occurring conditions
Stepwise SSRI/SNRI trial at OCD-appropriate dosing, with clear timelines
Consideration of clomipramine and antipsychotic augmentation when indicated
Coordination with ERP therapists, not duplication of their role
Structured Medication Management with vitals, labs, and side-effect reviews
Access to multiple APA California office locations and telehealth options when appropriate
You can learn more about our OCD-focused work on the OCD service page or move directly to booking via Schedule an appointment.
