How does Lexapro for OCD work? What you need to know.

The constant burden of obsessive thoughts and repetitive behaviors can be overwhelming for individuals living with OCD. Some medications are promising for OCD treatment though, including Lexapro (escitalopram). In this article, we explore the mechanism behind Lexapro for OCD and give you the information you need to better understand how Lexapro might help.

What is Lexapro? 

Lexapro (escitalopram) is a prescription medication in a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). An SSRI works by increasing the levels of serotonin, a neurotransmitter in the brain that regulates mood to alleviate symptoms of OCD. 

Lexapro is FDA-approved for the treatment of major depressive disorder in adults and children 12 and older and generalized anxiety disorder in adults and children 7 and older. Lexapro isn’t FDA-approved for treating OCD. So, why and how is Lexapro used for OCD?

The answer: research indicates that Lexapro is effective for treating OCD. As a result, healthcare providers are using it off-label to help people with OCD. Off-label is the practice of prescribing a medication for a condition or purpose it’s not approved for. 

What is OCD?

OCD is a mental illness or health condition estimated to affect 2.3% of people in the U.S., more often women than men. The exact cause of OCD and what affects OCD symptoms isn’t fully understood but is believed to involve genetic factors and abnormalities in certain brain pathways. 

Obsessions and compulsions are the key characteristics of OCD. Obsessions are unwanted and persistent thoughts, urges, or images that cause anxiety. These obsessions often revolve around specific themes, such as contamination, symmetry, rumination, harm, or false memories, and are intense enough to cause distress. 

Compulsions are repetitive behaviors or mental acts that someone is compelled to perform in response to their obsessions. These compulsions are often aimed at reducing anxiety or preventing a feared outcome. Although they can provide temporary relief, they can also be time-consuming and interfere with daily life. 

Does Lexapro work for OCD?

Lexapro may work for individuals with OCD. Taking Lexapro for OCD can also address depression, which often also affects people with OCD.

But how effective is Lexapro for OCD itself? 

A study conducted by Rabinowitz et al. evaluated the effectiveness and tolerability of high-dose escitalopram in patients with OCD. The study involved patients receiving a dose of 20 milligrams a day for 3 weeks after taking 10 milligrams a day for one week. The results showed promising outcomes, indicating that high-dose escitalopram may be effective in alleviating symptoms of OCD.

Another study compared the efficacy of escitalopram with sertraline (brand name Zoloft), another commonly used SSRI, for the treatment of OCD. The study, conducted by Mowla et al., indicated that escitalopram had comparable efficacy with sertraline in treating patients with OCD. Sertraline is FDA-approved to treat OCD. 

Both studies noted that their findings were preliminary, and larger double-blind controlled studies are needed to confirm the results. Nevertheless, case studies also support that escitalopram can be effective for treating OCD symptoms.   

What does Lexapro do?

Lexapro works by increasing the levels of serotonin in the brain. Serotonin transmits messages between nerve cells. Low levels of serotonin can lead to mood disorders, like depression and anxiety.

Serotonin is usually taken up into nerve cells after it passes between them. As an SSRI, Lexapro works by keeping serotonin from being taken up into nerve cells, so it stays in the space between them, which is thought to improve communication between cells.

The increase in serotonin levels between nerve cells is also thought to help regulate mood and emotions and help with the obsessions and compulsions of OCD.

What’s the best Lexapro dose for OCD?

Lexapro comes in 5-, 10-, and 20-milligram oral tablets. It’s taken once a day, either in the morning or in the evening, with or without food. It’s important to swallow the tablets whole with a full glass of water and not chew them.

The recommended Lexapro dose for OCD starts at 10 milligrams once a day. If necessary, the dose can be increased by 10 milligrams each week up to a maximum dose of 40 milligrams a day.

You want to consult with a healthcare provider before starting or adjusting the dose of any medication. Your provider will consider various factors, such as age, medical history, and individual response to treatment when determining the appropriate dose for you.

If you’re taking Lexapro and miss a dose, take the dose as soon as you remember. If, though, it’s already near the time for your next dose, skip the missed dose to avoid taking 2 doses at the same time. 

How long does Lexapro take to work for OCD?

Generally, OCD patients may see some improvement in sleep, energy, and/or appetite in the first 1 to 2 weeks on Lexapro. This improvement can be an important early signal that it’s working. It may take 6 to 8 weeks to see full improvements in depressed mood and lack of interest. And some providers recommend allowing up to 12 weeks of treatment to see a response. 

It’s important to keep in mind that everyone’s experience with medication is unique. If you start Lexapro, regularly follow up with your provider and talk to them about any progress you experience and about any concerns you have during and — if needed — between follow-ups.

What side effects does Lexapro have?

The most common side effects reported by people taking Lexapro include:

• Headache
• Diarrhea
• Nausea
• Sleepiness
• Weakness
• Dizziness
• Anxiety
• Insomnia
• Sexual problems
• Sweating
• Dry mouth
• Constipation
• Infection

These side effects are generally mild and may go away on their own as your body adjusts to Lexapro.

Serious Side Effects of Lexapro

Although less common, some serious side effects may occur when taking Lexapro. If you or someone you know experience any of the following more serious symptoms, contact your provider or seek medical attention. If you have heart rhythm changes or symptoms of serotonin syndrome, seek immediate medical help or call 911.

A risk of bone fractures is possible with prolonged use of Lexapro, especially in adults 50 and older.

A prolonged QT interval, which is an irregular heart rhythm that can be seen on an electrocardiogram and can cause potentially fatal cardiac arrhythmias or heart failure, has occurred in patients taking Lexapro.

Serotonin syndrome where too much serotonin is in the synapses of the brain can occur and be mild or life-threatening. Symptoms can include fast heart rate and fever, abnormal muscle movements that may include severe tremors and muscle rigidity, confusion, agitation, and seizures.

Changes in appetite or weight can happen while taking Lexapro. It’s recommended that children and adolescents have their height and weight monitored during treatment. 

Low salt levels in the blood, also known as hyponatremia, can occur, especially in elderly individuals. Symptoms of low salt levels include weakness, feeling unsteady, confusion, problems concentrating or thinking, memory problems, and headaches.

Visual problems can also be a potential side effect of Lexapro. These can include eye pain, changes in vision, and swelling or redness in or around the eye. Lexapro may cause angle closure glaucoma in people with anatomically narrow angles who haven’t had corrective surgery. 

Severe allergic reactions, although rare, can occur. Symptoms of a severe allergic reaction may include swelling of the face, tongue, eyes, or mouth, rash, itchy welts (hives) or blisters, and trouble breathing.

Cognitive and motor impairment can occur in some individuals taking Lexapro. If you take Lexapro avoid operating a car or other heavy machinery until you’re certain it doesn’t interfere with your ability to drive.

Abnormal bleeding can be a serious side effect of Lexapro and other antidepressant medications. Using Lexapro may increase the risk of bleeding or bruising, especially if you also take medications, such as blood thinners or nonsteroidal anti-inflammatory drugs.

Manic episodes are a potentially serious side effect of taking Lexapro. Symptoms include increased energy, severe trouble sleeping, racing thoughts, reckless behavior, unusually grand ideas, excessive happiness or irritability, and talking more or faster than usual.

Suicidal thoughts or actions. Lexapro and other antidepressant medications have a box warning from the FDA because they may increase the risk of suicidal thoughts or actions, particularly in children, teenagers, or young adults. It’s critical to monitor for any changes in mood, behavior, actions, thoughts, or feelings, especially when starting or changing your dose of Lexapro. 

Sexual dysfunction can occur when taking an SSRI like Lexapro. It’s important to maintain an open dialogue with your medical provider if you have any concerns.

Seizures or convulsions have happened when taking Lexapro.

What to know when considering Lexapro

Know that Lexapro may not work for you. If it doesn’t there are other treatment options, including some listed below. If you’re considering Lexapro, be aware of the following.

• Tell your provider if you’re pregnant or breast-feeding, because Lexapro may lead to health problems in newborns. 
• Avoid marijuana and other forms of cannabis as well as prescription or over-the-counter (OTC) drugs that may slow your actions. 
• Avoid driving and doing other tasks or actions that require you to be alert until you know how Lexapro affects you. 
• Use Lexapro with care if you’re 65 or older. 
• Don’t combine Lexapro with other SSRIs to avoid serotonin syndrome. Tell your doctor about any medications you’re taking so they can adjust your medications accordingly.
• Avoid combining Lexapro with non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and Warfarin, which can increase your risk of bleeding. If you take an antiplatelet or anticoagulant medication, tell your doctor before you take Lexapro.
• Avoid alcohol to reduce the risk of side effects. Lexapro may cause dizziness and low blood pressure, and alcohol can intensify these effects, leading to increased dizziness and a greater risk of falls. Lexapro’s effectiveness may also be affected by alcohol. Consult with your healthcare provider about the potential risks and benefits before consuming alcohol while taking Lexapro.
• Use caution when taking Lexapro with medications that are metabolized by CYP2D6. The CYP2D6 enzyme affects the metabolism of several medications, including Lexapro. 

Additionally, Lexapro may not be suitable for you if you have medical conditions, including diabetes, heart disease (especially long QT syndrome and other conduction disorders), conditions that cause electrolyte imbalances, kidney or liver problems, bipolar disorder, a history of seizures or fits, and certain eye problems.

And, if you have impaired liver function, use caution when taking Lexapro, which is metabolized by the liver enzyme CYP2C19. You can be tested to find out what your CYP2C19 enzyme activity is. If you’re found to be a poor metabolizer of CYP2C19, Lexapro concentrations in your bloodstream may go up, which increases your chance for adverse reactions. 

When not to take Lexapro

Some individuals simply shouldn’t take Lexapro.

If you’re allergic to escitalopram oxalate or citalopram hydrobromide, or any of the ingredients in Lexapro, don’t take it. 

If you’re currently taking a monoamine oxidase inhibitor (MAOI) or have taken an MAOI, like linezolid or intravenous methylene blue, within the last 2 weeks, don’t start taking Lexapro without the guidance of a healthcare provider. 

Combining Lexapro with an MAOI can lead to serious, even life-threatening, side effects. Talk to your healthcare provider or pharmacist if you’re not sure if you’re taking an MAOI.

Pimozide (Orap), a medication used for Tourette’s syndrome, shouldn’t be combined with Lexapro as it can lead to increased plasma concentrations of pimozide and cause an increased risk of developing QT prolongation or ventricular arrhythmias. 

If you and your provider decide Lexapro is right for your OCD symptoms, it’s important to know what to expect if and when you stop taking it?

What happens if you stop Lexapro? 

Stopping Lexapro abruptly can cause symptoms. The most frequent symptoms of withdrawal from Lexapro include dizziness, vertigo, nausea, vomiting, flu-like symptoms, sensory disturbances (for example, paresthesias, electric shock sensation), dysphoric mood (a state of unease or generalized dissatisfaction), impaired memory, irritability, anxiety, and/or agitation, confusion, headache, lethargy, insomnia, and hypomania.

To avoid becoming dependent on Lexapro, follow your provider’s guidance and treatment plan. Gradual tapering off of it under the supervision of your healthcare provider will minimize the likelihood and severity of having withdrawal-like symptoms. 

While Lexapro itself isn’t typically abused for recreational purposes, misuse may occur in individuals struggling with other substance use disorders or mental health issues. Overconsumption of Lexapro or feigning symptoms to obtain more from healthcare providers are signs of potential misuse.

If you stop Lexapro for any reason or decide not to start, there are alternatives.

What alternative OCD medications are there?

While Lexapro is a commonly prescribed SSRI for OCD, other medications may help OCD patients manage the condition. Some of these are included below.

*Using a medication off-label is using it for a condition other than what it was approved for and should only be done if your provider deems it medically necessary.

Should you combine OCD therapy and Lexapro for OCD?

Combining therapy and medication, such as Lexapro, is the most comprehensive treatment approach for OCD because therapy is an essential component of treatment.

In therapy, you work with a therapist who equips you with tools and strategies to better understand and cope with your OCD symptoms. Therapy can also help you address underlying issues or triggers that may be contributing to OCD symptoms.

Along with medication, cognitive-behavioral therapy (CBT) is often used for OCD treatment. CBT includes techniques, such as psychoeducation and cognitive therapies including exposure therapy and response prevention (ERP), which help people confront feared situations and gradually reduce anxiety. 

Techniques like exposure and response prevention help individuals gradually confront their fears and develop healthier coping strategies. This combination of therapy and medication is shown to be more effective than medication alone.

Family therapy can also be useful. It involves the whole family in the treatment process to help everyone understand OCD and its impact, improve communication, and provide support for the individual or family members with OCD. 

How to get a prescription for Lexapro

Providers who offer mental health therapy don’t typically have a license to prescribe medication. And different providers will be involved in a treatment plan that includes medication and therapy. 

To get a prescription for Lexapro, you need to see a healthcare provider with credentials to prescribe medication. Providers who prescribe medications are typically psychiatrists, medical doctors, registered nurses, or physician assistants. 

Key takeaway 

Lexapro is a medication that affects certain chemicals in the brain, specifically serotonin. It’s not fully understood how SSRIs, like Lexapro, relieve OCD symptoms, but it’s believed that they affect serotonin activity in the brain, which helps regulate mood and reduce anxiety.

While Lexapro isn’t specifically approved by the FDA for the treatment of OCD, evidence suggests that it may be effective in managing OCD symptoms. A combination of therapy and medication can have a positive impact on your quality of life. If you suffer from OCD, it’s easy to find treatment providers that can help. 

Find a telehealth provider for therapy and/or a Lexapro prescription for OCD 

Finding a telehealth provider for a prescription of Lexapro or seeking alternatives to Lexapro for OCD is easy on online platforms like Klarity. On Klarity you can find a licensed therapist and psychiatric provider who specialize in therapy and medication management for OCD treatment.

Get started toward relief for your OCD symptoms by finding a provider on Klarity today.

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.