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The standard and most effective treatment for obsessive-compulsive disorder (OCD) is a combination of medication and cognitive behavioral therapy (CBT). The first choice of medication for OCD is serotonin reuptake inhibitors (SSRIs). Commonly prescribed SSRIs for OCD include Celexa, Prozac, Luvox, Paxil and Zoloft. SSRIs are ineffective in approximately 40 percent of patients with OCD. Effexor may help patients who do not respond to SSRIs.
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How Effexor Works
Effexor (Venlafaxine) is a serotonin-norepinephrine reuptake inhibitor (SNRI). Effexor affects two neurotransmitters, serotonin and norepinephrine; SSRIs only affect serotonin. It is believed that people who have OCD are low on serotonin. SSRI and SNRI medications slow the reuptake of serotonin, increasing the amount of the neurotransmitter available to the brain. Effexor also increases norepinephrine availability in the brain; however, there are no documented benefits of increased norepinephrine availability in the treatment of OCD. The norepinephrine activity of Effexor may reduce depressive symptoms. Boosting norepinephrine availability in certain individuals may cause a feeling of well-being and boost mood. Although, excess amounts of norepinephrine can produce opposite results, causing anxiety.
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There is relatively little scientific data on the effectiveness of Effexor in treating OCD symptoms. Results from the limited studies show that the medication may work to relieve the symptoms of OCD in some people. More research is needed to learn about the effectiveness of Effexor for obsessive-compulsive disorder.
One small study found that 75.9 percent of study participants with OCD who had not responded to one or more SSRIs, experienced some relief of symptoms from taking Effexor [ J Clin Psychiatry. 2003 Aug;64(8):972]. The researchers warned the results should be looked at with caution, due to the limited size of the study.
The 2007 American Psychiatric Association treatment recommendations for obsessive-compulsive disorder stated that Effexor was "less likely to produce an adequate response" in OCD treatment compared to SSRIs.
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At this time there is not sufficient evidence to suggest that Effexor should be prescribed as a first-line treatment for OCD. SSRI's appear to produce better and more reliable results in most individuals, which is why they are the preferred choice of OCD treatment. Some believe that for the 40 percent who fail to respond to SSRIs, Effexor is worth trying and may be effective.
The U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality recommends against prescribing Effexor for OCD unless comorbidity exists, meaning another illness is also present. Effexor may be useful in treating OCD when SSRIs fail to work or when other conditions such as depression or body dysmorphic disorder coexist with OCD.
Because there is no way of knowing which of the OCD medications will effectively treat OCD in each individual patient, it is not uncommon for several medications and different dosages to be tried before one that works is found. Some people respond best when taking multiple medications concurrently. Each individual has a unique brain chemistry and responds differently to each medication. Finding the right one is a process of trial and error. Some people are fortunate and respond well to the first medication tried. Others may need to experiment with several types of medication before finding one that works. It takes several weeks to know if a particular medication is working.
Finding the right medication may even take several months to a year, depending on how many different medications the patient needs to try. To assist doctors in finding the best medications and dosages, patients should share any new symptoms with their doctors and any side effects they experience from the medication.
Until more research is conducted, Effexor remains a second-line treatment for OCD.
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Effexor is not generally recommended for children who are under 18, except in certain circumstances as determined by a doctor. A person of any age may experience suicidal thoughts or display suicidal behavior from taking Effexor; the risks are higher in individuals under the age of 24 years old. The exact percentage of increased risk of suicidal thoughts and behavior are unknown; doctors and family members should closely observe young adults and children for possible signs of this serious side effect.
Generally, Effexor is well tolerated and produces minimal side effects. However, Effexor is not the right medication for everyone. As with all medications, it carries the risk of side effects -- ranging from minor to serious -- and should not be taken with certain medical conditions or with some medications. Talk to your doctor about the possible side effects and risks before taking Effexor for OCD.
NB: The content of this article is for information purposes only and is not intended to replace sound medical advice and opinion.
- U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality; Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder: http://www.guideline.gov/content.aspx?id=9369
- Phelps NJ, Cates ME; Western Missouri Mental Health Center; The Role of Venalfaxine in the Treatment of Obsessive-Compulsive Disorder; Ann Pharmacother. 2005 Jan;39(1):136-40. Epub 2004 Dec 7
- MedlinePlus; Venlafaxine; http://www.nlm.nih.gov/medlineplus/druginfo/meds/a694020.html
- Hollander, E. et al; Venlafaxine in Treatment-Resistant Obsessive-Compulsive Disorder; J Clin Psychiatry. 2003 Aug;64(8):972
- Lambert, Mara; APA Releases Guidelines on Treating Obsessive-Compulsive Disorder; Am Fam Physician. 2008 Jul 1;78(1):131-135