Supplements for Obsessive Compulsive Disorder by Robert Hudak, MD
Q: Are there supplements or other over-the-counter options for the treatment of OCD?
There have been numerous studies looking at the use of supplements in the treatment of OCD. These supplements, which are sometimes referred to as “nutraceuticals,” are typically sold over the counter at drugstores or health food stores in the United States. However, none of these has been found to be effective as a stand alone treatment for OCD in controlled studies
It is important to know that none of these supplements are considered first line for the treatment of OCD. Do not rely on any of these products instead of medication prescribed by an experienced health care practitioner and behavioral therapy.
In fact, most of the research on these products examined their benefit when added to an SSRI, which are considered first-line treatment, and not as stand-alone use. And as of now, there aren’t any that are considered promising enough that they would be used on a regular basis.
No supplements should be used for OCD (or other psychiatric disorders) without first discussing the issue with your doctor.
Q: Are these over-the-counter supplements safe to take?
It is important to note that “all natural” does not mean “safe to use.” Most over-the-counter supplements are not as strictly regulated by the FDA as medications sold by prescription are. Therefore, the quality of ingredients or even the dosage listed can be variable.
It is usually best to buy products from respected manufacturers. There can also be interactions with medications you may be taking, including medications for OCD. Therefore, you should never take an over-the-counter supplement without checking with your doctor first.
Q: Should supplements be thought of as a primary treatment for OCD or as an add-on?
A: Most of the time, supplements have been studied as add-on treatment, although there are some exceptions. But please remember, these supplements should never be used without your doctor’s advice.
Q: Which supplements have the best chance of helping with my OCD? I am hearing a lot about NAC lately.
NAC is also known as n-acetyl-cysteine. A review study published a few years ago indicated that NAC might be helpful in the treatment of OCD. AS a result, many doctors have heard about NAC for OCD and recommend it to their patients.
However, this study suffered from some serious flaws and generally should not be used as a basis to recommend NAC. A follow-up study showed that NAC did not work as an add-on treatment for OCD. Therefore, NAC is generally not recommended as a routine add-on treatment for OCD. Please do not confuse this with the use of NAC for body-focused repetitive behaviors, where it is increasingly used as a first-line treatment.
Q: What other supplements are of interest in OCD?
A: One that has been studied is inositol. It can be bought over-the-counter in the United States, especially at health food stores. This is one supplement that may be better as primary treatment, as it was found to work as a stand-alone treatment but did not work when added on to SSRI medication. However, it is important to note that the dose that has to be used to get an effect is very high- 18 grams a day- and the person has to build up to that dose gradually. Most of the time, people stop taking it before getting up to a dose that high due to gastrointestinal distress, such as bloating and diarrhea.
Tryptophan is an amino acid that the body uses to make serotonin, so as a result this has been looked at as an add-on treatment. Some psychiatrists have published very small studies in which it showed some benefit. However, it hasn’t been looked at using what researchers consider the gold standard of studies- a double blinded, placebo controlled trial. In addition, this supplement was withdrawn from the market in 1990 because it contained a contaminant that lead to illness and, in some cases, death. It is back on the market for sale now, but is only recommended by psychiatrists in exceptional circumstances.
St. John’s Wort is also known as hypericum and has been used successfully for depression. There was one study in OCD that did not show effectiveness, however. It is important to note that taking St John’s Wort and other psychiatric medication together can potentially be dangerous and should only be done under a doctor’s supervision.
Caffeine is sold over the counter in pill form. It gets talked about occasionally because it was used as a placebo in one study, meaning the authors expected OCD patients to get no response to it. Instead, there was a response in some patients. Caffeine has never been explored beyond this, and people are encouraged not to experiment with caffeine pills on their own, as it is potentially dangerous in high doses.
The bottom line is that there is a lot that we don’t know about the use of over-the-counter supplements for OCD. As of now, there aren’t any that are considered promising enough that they would be used on a regular basis. No supplements should be used for OCD (or other psychiatric disorders) without first discussing the issue with your doctor.