OCD Medication Side Effects: The Tradeoff We Often Have to Make
Whether it is an SSRI or another psychiatric medication, side effects seem almost unavoidable. Over the years, I feel like I have experienced most of them at one point or another. Insomnia, increased appetite, reduced appetite, sexual dysfunction, weight gain, weight loss, fatigue, and restlessness have all made appearances during my treatment journey.
As I write this, it is 4:32 in the morning. I woke up around 2:00 AM and, once again, only managed a few hours of sleep. Despite taking melatonin and feeling exhausted, I often find myself unable to stay asleep for long. I currently take Prozac (fluoxetine) at 80 mg and Abilify (aripiprazole) at 5 mg daily. While I still experience some side effects, I consider myself fortunate because this combination has been easier for me to tolerate than several medications I have taken in the past.
For me, the benefits outweigh the side effects. These medications have helped reduce the intensity of my compulsions and made it easier to engage in exposure and response prevention (ERP) therapy. I was never expecting a cure for OCD, but any reduction in compulsions is a victory.
This is also why I believe OCD is more than simply a psychological problem. Research has shown differences in brain activity and functioning among people with OCD. While therapy remains essential, medication can be an important tool that helps many people participate more effectively in treatment. Some individuals succeed with ERP alone, while others benefit from combining therapy with medication.
My Experience With Clomipramine
One medication that helped me significantly was Clomipramine (Anafranil). Unlike Prozac, Clomipramine is a tricyclic antidepressant rather than an SSRI. It is often considered one of the most effective medications available for OCD and is frequently prescribed when SSRIs do not provide enough relief.
Although Clomipramine helped my OCD symptoms, it also produced side effects that eventually became difficult to ignore. I experienced unusual electrical shock-like sensations in my legs, difficulty sleeping, and significant sexual dysfunction. While the medication was effective, those side effects were challenging to live with.
Living in Vietnam created another obstacle. Clomipramine is not widely available here, making long-term treatment more complicated than it would be in some other countries.
The Strange "Benefit" of Early SSRI Side Effects
One side effect that many people dislike is the mental fogginess that can occur when starting an SSRI. Oddly enough, I never completely hated that feeling.
During the first week or so of starting an SSRI, I often felt emotionally detached and less concerned about my OCD. It was not a healthy long-term solution, and the effect always faded as my brain adjusted to the medication, but for a brief period it felt like OCD had lost some of its power over me.
Unfortunately, that sensation never lasted. Within a week or two, my mind would adapt and things would return to normal.
Appetite Changes and Weight Management
The side effect I disliked the most was increased appetite. As someone who has worked hard to lose a substantial amount of weight, constantly feeling hungry was incredibly frustrating. Some days it felt like I could eat endlessly if I allowed myself to.
At one point, I relied heavily on willpower to avoid late-night eating and protect the progress I had made. Fortunately, after switching from risperidone to Abilify, that intense hunger largely disappeared. The difference was noticeable and made maintaining my weight-loss goals much easier.
Ironically, Prozac has had the opposite effect on me. It tends to reduce my appetite, which has actually been helpful while trying to lose weight. Not every side effect is negative. Sometimes a side effect that bothers one person may actually benefit someone else.
Everyone's Experience Is Different
One thing I have learned is that psychiatric medications affect everyone differently. A medication that causes severe side effects for one person may be easy for another person to tolerate. Finding the right treatment often involves patience, trial and error, and working closely with a qualified psychiatrist.
For me, the goal has never been perfection. The goal is to reduce OCD enough that I can live my life, participate in ERP, and spend less time trapped in compulsions. If a medication helps me move closer to that goal, some side effects may be worth accepting.
What side effects have you experienced? Have any of them unexpectedly helped you? I'd love to hear your story.