Lexapro for OCD: Can It Help with Obsessive-Compulsive Disorder?
Author:
Blossom Editorial
Aug 22, 2025
Lexapro (escitalopram) is a popular antidepressant that doctors sometimes give to people with obsessive-compulsive disorder (OCD), even though it's not officially approved for this use.
The use of Citalopram (Celexa) and Escitalopram (Lexapro) for OCD is also well supported with data and both medications appear to be just as effective as the other SSRIs. Escitalopram (Lexapro) is approved in Europe for treatment of OCD.
If you're dealing with OCD symptoms, learning how this medication might help can guide your treatment choices with your doctor.
Key Takeaways
While Lexapro isn't FDA-approved for OCD in the US, yet research shows it works just as well as other approved medications for reducing obsessions and compulsions.
OCD usually needs higher doses of Lexapro (often 40mg daily) than depression or anxiety (20mg), and it takes 8-12 weeks to see full results.
Combining Lexapro with special OCD therapy gives better results than medication alone, since only about 1 in 5 people get complete relief from medication by itself.
What is OCD?
Obsessive-compulsive disorder is a mental health condition that causes unwanted, repeating thoughts (obsessions) and behaviors you feel you must do over and over (compulsions). Obsessive-compulsive disorder (OCD) affects up to 2.5% of people during their lifetime.
Common obsessions include worrying about germs or getting dirty, fears that something terrible will happen, needing things to be "perfect" or in exact order, and unwanted violent or sexual thoughts.
Compulsions often involve washing hands or cleaning too much, checking doors and locks over and over, counting or arranging items, and repeating words or prayers silently.
These symptoms take up a lot of time each day and make it hard to work, go to school, or enjoy relationships. Untreated OCD usually runs a long-term course, going up and down but rarely going away completely.
How Common is OCD?
Large studies have shown that 2–3% of people around the world have OCD at some point in their lives, though some newer studies suggest slightly lower numbers, around 1.6%.
OCD rarely happens alone. It's estimated that around 76% of people with OCD also have an anxiety disorder, and 41% have depression. This is why Lexapro's ability to treat anxiety can be especially helpful for people with OCD.
What is Lexapro?
Lexapro is the brand name for a medication called escitalopram. It belongs to a group of antidepressants called SSRIs (selective serotonin reuptake inhibitors).
Escitalopram is the pure form of an older medication called citalopram. Not only is escitalopram the most targeted of the SSRIs, it also doesn't have the parts that might interfere with how well it works.
The medication comes as tablets in 5mg, 10mg, and 20mg sizes, plus a liquid form. While the FDA approved Lexapro for depression and anxiety disorders, doctors can give it "off-label" for other conditions like OCD when research shows it helps.
Learning how SSRIs work for different conditions helps explain why your doctor might choose Lexapro for your OCD treatment.
How Does Lexapro Work for OCD?
The selective serotonin reuptake inhibitors (SSRIs) are the main medicines used to treat OCD. These medications work by keeping more serotonin available in your brain. Serotonin is a chemical messenger that helps control mood, anxiety, and behavior.
Think of it like this: your brain cells normally soak up serotonin quickly after using it. SSRIs block this process, so more serotonin stays active between brain cells. This extra serotonin helps reduce obsessive thoughts and the urge to do compulsive behaviors.
The exact reason why this works isn't fully understood, but Lexapro can help alleviate obsessions, compulsions, and related anxiety—and, in many cases, it allows people to experience greater results from ERP therapy.
What makes OCD different from other conditions is that it affects brain circuits differently than depression or regular anxiety, which explains why treatment needs to be different.
Research on Lexapro for OCD
Studies show that Lexapro can work well for OCD, even though it doesn't have official approval for this use in the United States.
Clinical Studies
The most important study was done by Stein et al (2007), who did the only major study of escitalopram in OCD that also compared it to a fake pill and another real medication called paroxetine. This study looked at 455 people with OCD over 24 weeks.
Doses of 20 mg escitalopram and paroxetine worked better than fake pills at 12 weeks, and all three real treatments worked better than fake pills at 24 weeks. When compared to fake pills, the 20 mg escitalopram dose started working sooner and worked better than the 10 mg dose throughout the whole study.
How Well Does It Work Compared to Other Medications?
When researchers compared Lexapro to other OCD medications, they found similar results. Studies showed that escitalopram works just as well as sertraline for treating obsessions and compulsions in people with OCD. In this study,
In the escitalopram group 15 (70%) patients, and in the sertraline group 16 (76.19%) patients had their symptoms get more than 34% better by the end of the study.
These results suggest that Lexapro works about as well as medications that are officially approved for OCD.
Real-world case studies also show good results. All 3 patients got better with escitalopram treatment: their OCD scores dropped by more than 50%, and doctors rated them as having "much improvement."
Lexapro Dosing: OCD vs. Other Conditions
One of the biggest differences when using Lexapro for OCD is that you'll likely need a higher dose than someone taking it for depression or anxiety.
Why Higher Doses are Needed
When treating OCD, clinicians may use higher doses of Lexapro than they do for anxiety or depression. A daily 40mg dose of Lexapro is typical for OCD patients, while 20mg is a typical dose for people with depression.
The reason for this difference is how OCD affects the brain. SSRIs work differently for depression than they do for OCD. For OCD, higher doses often work better and help more people get better.
What the Research Shows About Different Doses
A study looking at different dose levels found clear benefits from higher doses.
In this study, about 25% of people got very high doses (average 57mg), 38% got high doses (average 34mg), and 37% got standard doses (average 13mg).
People taking higher doses had better response rates: 46% of very high dose patients got much better, 43% of high dose patients got much better, but only 26% of standard dose patients got much better.
This means people taking higher doses were more likely to see big improvements in their OCD symptoms.
Learning about the timeline for improvement is just as important as getting the right dose.
How Long Does Lexapro Take to Work for OCD?
You need to be patient when starting Lexapro for OCD. Unlike depression or anxiety, OCD takes longer to respond to medication.
A good trial of an SSRI for OCD needs 8 to 12 weeks, with at least 6 of those weeks at the higher doses needed for OCD treatment. To know if it's working, you'll need to wait at least 12 weeks.
This timeline is much longer than what you might expect if you've taken antidepressants before. Lower doses of SSRIs used for anxiety and depression change different parts of the brain, a process that happens faster.
Some people might notice small improvements in anxiety within a few weeks, but the real benefits for OCD symptoms usually don't show up until you've been on the right dose for at least 2-3 months.
Learning about possible side effects can help you prepare for what to expect during treatment.
Side Effects of Lexapro and What to Expect
Like all medications, Lexapro can cause side effects. The good news is that most are mild and often get better as your body adjusts to the medication.
Common Side Effects
The most frequent side effects include:
Stomach-related:
Nausea (especially in the first few weeks)
Diarrhea or constipation
Loss of appetite
Sexual problems:
Less interest in sex
Difficulty reaching orgasm
Erectile problems in men
Sleep and energy:
Feeling sleepy or having trouble sleeping
Headaches
Dizziness
Other effects:
Dry mouth
Sweating more than usual
Feeling restless or jittery
What to Know About Sexual Side Effects
Sexual side effects are common with SSRIs. According to a review of studies, between 28% and 75% of both men and women who take an SSRI experience some side effects related to sexual desire and performance.
However, 9 to 14% of people prescribed Lexapro reported experiencing ejaculation disorder in clinical trials, with three % reporting erectile dysfunction (ED). The actual numbers in real life might be different.
Will Side Effects Get Better?
Many side effects improve over time. Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long-lasting and may not get better even after stopping the medicine.
If side effects bother you, don't stop the medication on your own. Your doctor can help by:
Adjusting your dose
Changing when you take it (morning vs. evening)
Adding other medications to help with side effects
Switching to a different SSRI if needed
Knowing when to get medical help is important for safe treatment.
When to Seek Medical Attention
While Lexapro is generally safe, there are times when you should contact your doctor right away.
Call your doctor immediately if you have:
Thoughts of hurting yourself or suicide (especially if you're under 25)
Severe mood changes or feeling much worse
Signs of an allergic reaction (trouble breathing, swelling, severe rash)
High fever with confusion, fast heartbeat, or muscle stiffness
Contact your doctor soon if you experience:
Side effects that don't get better after a few weeks
Problems that interfere with your daily life
No improvement in OCD symptoms after 12 weeks
New or worsening anxiety or depression
Pediatric patients being treated with antidepressants for any indication should be closely observed for clinical worsening, as well as agitation, irritability, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.
Understanding how Lexapro works with therapy can help you get the best results.
Combining Lexapro with OCD Therapy
Medication alone rarely "cures" OCD completely. Most people have some improvement, although fewer than 20% of those treated with medication alone will have a complete remission of symptoms. This is why medication is often combined with cognitive behavior therapy (CBT) to get more complete and lasting results.
What is ERP Therapy?
The best therapy for OCD is called Exposure and Response Prevention (ERP). This therapy helps you face your fears gradually while learning not to do compulsive behaviors.
Lexapro can help ease anxiety and lower the intensity of obsessive thoughts and compulsive urges, which may make ERP therapy feel more manageable. Think of medication as making the therapy work better by reducing your anxiety enough so you can practice the skills you learn.
How Well Does the Combination Work?
Approximately 70% of patients can experience significant symptomatic relief with appropriate pharmacotherapy. When medication is combined with ERP therapy, success rates are even higher, and the improvements tend to last longer.
Some people find it helpful to reduce (but not eliminate) their anxiety through medication before starting ERP, but the right approach varies depending on the individual's needs and treatment plan.
Considering whether Lexapro is right for you involves weighing several factors.
Is Lexapro Right for Your OCD?
Deciding whether to try Lexapro for OCD depends on your specific situation, symptoms, and medical history.
When Lexapro Might Be a Good Choice
Lexapro could work well for you if:
You have both OCD and anxiety or depression
You're starting medication for the first time
You want a once-daily medication
You haven't had success with other treatments
You need something to help make therapy easier
When Other Options Might Be Better
You might want to consider FDA-approved OCD medications instead if:
You prefer medications specifically approved for OCD
You've had good results with other SSRIs before
You have medical conditions that make Lexapro less suitable
You experience too many side effects with escitalopram
What Are the FDA-Approved Alternatives?
Four SSRIs that have been shown to be effective in treating OCD and are FDA-approved to treat adults with OCD in the United States are: Zoloft, Prozac, and Luvox have also been approved for use with children 6, 7, and 8 years of age and above, respectively. There's also Paxil for adults and Anafranil (clomipramine), which is an older medication.
All the SSRIs and Clomipramine appear to be equally effective for the treatment of OCD, so the choice often comes down to side effects, dosing convenience, and personal response.
Thinking about long-term treatment is important when starting any OCD medication.
Medical Disclaimer
This article is for educational purposes only and does not constitute medical advice. The information provided should not replace consultation with a qualified healthcare provider. Individual responses to medications can vary significantly, and what applies to one person may not be safe for another.
Always consult with your doctor or pharmacist before making any decisions about medication changes, discontinuation, or interactions with other substances. If you're experiencing concerning symptoms or side effects, please seek professional help from a healthcare provider. In case of a medical emergency, contact your local emergency services immediately or call 911. For mental health emergencies, contact the National Suicide Prevention Lifeline at 988.
Important: This information is not a substitute for professional medical advice. Never stop taking prescribed medication or make changes to your treatment plan without consulting your healthcare provider first. Your safety and well-being are the top priorities.
Sources
An emerging role for escitalopram in the treatment of obsessive-compulsive disorder - PMC
High-dose escitalopram for the treatment of obsessive-compulsive disorder - PubMed
Escitalopram in Obsessive-Compulsive Disorder: A Case Series - PMC
Escitalopram prevents relapse of obsessive-compulsive disorder - ScienceDirect
Pharmacological treatment of obsessive-compulsive disorder - PMC
Suicidality in Children and Adolescents Being Treated With Antidepressant Medications | FDA
Sexual side effects of SSRIs: Why it happens and what to do - Harvard Health
