Medication Management & Realities for BIPOC Individuals Living With OCD

by Erin Nghe, LCSW

While Obsessive Compulsive Disorder (OCD) does not have a known cure, effective forms of treatment like Exposure and Response Prevention (ERP) and pharmacotherapy can greatly reduce symptoms for individuals living with OCD. Specifically, serotonin reuptake inhibitors (SRIs) have been found to be most useful for OCD and higher doses are needed compared to SRIs being used for other psychiatric disorders. For the 70 percent of individuals that do benefit from medication, their symptoms are reduced by as little as 40, but up to 60 percent. BIPOC individuals struggling with OCD however, have more challenges than simply deciding between whether they should take medication versus not. BIPOC individuals often navigate the complexity of making this major decision while also facing the realities of historical medical injustices like:

• Ancestral trauma related to the 40-year U.S. Tuskegee experiment (1932-1972) where 600 Black men were enrolled in a study for STIs and treatment was withheld unbeknownst to them
• Bayer corporation of Bayer Aspirin distributing HIV and hepatitis within their blood products in the early 80s for hemophilia patients in Asia and Latin America
• Misconceptions about Black bodies being stronger than white bodies in studies where medical students and residents offered inadequate pain management due to bias in 2016
• People of color being significantly underrepresented in clinical health trials overall 

BIPOC Empowerment and Medication

These inequalities have led to a real distrust in the healthcare system and should be honored within yourself and by your medical and mental health providers. So how do you move forward with exploring pharmacotherapy in spite of your concerns? Below are a few tips to support you in your decision making: 

1. Feel empowered to ask your providers questions and be honest and up front with your therapist and psychiatrist about your concerns, including historical trauma or stigma.
2. Speak with your ERP specialist about how OCD can even latch onto medication fears and involve compulsions including avoidance, overly seeking reassurance and research.
3. Interview a few psychiatrists or psychiatric nurse practitioners if they offer brief consultations before deciding on their services.
4. Research the medication for yourself as it will allow you to feel more empowered, but be sure this doesn’t become a googling compulsion.
5. Before deciding on a provider, be empowered to ask therapists and psychiatrists questions to ascertain their cultural competency and comfort level with discussing your concerns about historical injustices impacting your decisions.
6. Be aware that the field of psychiatry is growing and these days you may have great success in finding a prescriber that looks like you. 
7. Consider working with prescribers that take your concerns about side effects seriously as BIPOC medical seekers have often experienced gaslighting from the medical community. 

General Medication Tips:

• Some prescribers may be open to discussing natural options or supplements like NAC, though this may not be the case for every psychiatrist.
• Be aware that some ERP specialists and psychiatrists may discuss medications like benzodiazepines (Valium, Xanax, Ativan and Klonopin) being contraindicated to effectively engaging in ERP.
• If finances are an issue, utilizing your GP may be a decent first step if there are no other options for getting access to medication through a psychiatric provider.
• If psychiatrists are too expensive or have long waitlists, a psychiatric nurse practitioners may be a more affordable/accessible option.
• Genetic testing may be an option, though it is an expensive one and isn’t the first line of defense. This test isn’t always offered by psychiatrists as it has historically been controversial in nature because it doesn’t tell you if the medication will work. Genetic testing however may inform psychiatrists about whether a person’s body will process medication quickly or slowly and this can help with some prediction of side effects. It is useful for people with known genetic issues related to methylation. 
• If you’re interested in increasing or stopping your medication, always be sure to do so under the guidance of a prescriber rather than doing so on your own
• Ask your prescriber about whether combining medications, (known as augmentation) is right for you. This isn’t the case for everyone, but some individuals may require more than one medication.  
• Talk with your prescriber and ERP specialists about dependency and SRIs as there are often misconceptions about this. 

Medication Dosages Are Important:

As aforementioned, for individuals living with OCD, SRIs are likely needed at higher doses and be aware that not all SRIs are created equal. The following are recommended according to the research:

Clomipramine (Anafranil) – Up to 250 mg/day

Fluoxetine (Prozac) – 40-80 mg/day

Fluvoxamine (Luvox) – Up to 300 mg/day

Paroxetine (Paxil) – 40 – 60 mg/day

Sertraline (Zoloft) – Up to 200 mg/day

Citalopram (Celexa) – Up to 40 mg/day

Escitalopram (Lexapro) – Up to 40 mg/day

Venlafaxine (Effexor) – Up to 375 mg/day

ERP Kaleidoscope care about all of your concern, including your historical trauma, medication and OCD concerns. We invite you to join our advocacy groups and support groups so that your voice can be heard about these concerns and more. 

About the Author

Erin Nghe, MSW, LCSW: Erin Nghe is the Co-founder of ERP Kaleidoscope. She is also the owner of OCD Set Free, an interactive mental health treatment experience where she serves individuals living with OCD in Georgia, Florida and Alabama and trains therapists in offering ERP.