Intrusive thoughts can be frightening and deeply unsettling—often occurring randomly, without warning. While these thoughts can be a normal part of the human experience, they can become problematic if they occur often or start interfering with daily life. Sometimes, intrusive thoughts can be a sign of a mental health condition such as post-traumatic stress disorder (PTSD), eating disorders, anxiety disorders, depression, psychosis, or obsessive-compulsive disorder (OCD).
For OCD, intrusive thoughts take the form of obsessions, and can cover a wide range of topics—often causing significant anxiety and provoking compulsions.
While there aren’t medications designed specifically to eliminate intrusive thoughts, some can help you manage symptoms associated with these thoughts. Read on to learn more about these medications, how they work, and how to use them in combination with the most effective treatment for OCD—exposure and response prevention (ERP) therapy.
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What are intrusive thoughts?
Intrusive thoughts are unwanted, repetitive, and distressing ideas, images, feelings, or urges that can cause intense anxiety. These thoughts might be violent, sexual, or irrational, and are ego-dystonic—meaning they don’t align with who you really are, or what you really want.
However, OCD can make you feel like these thoughts hold more meaning than they actually do. Even though deep down you know that they aren’t a reflection of who you really are, OCD obsessions can cause you to question your own morality. And, the more you try to get rid of them, the stronger they can become—trapping you in a cycle of symptoms.
Examples of intrusive thoughts
- Harm: “What if I accidentally hurt someone?” What if I act on a violent thought?”
- Relationships: “What if I don’t really love my partner?” “What if I’m secretly attracted to someone else and don’t realize it?”
- Religion: “What if I’ve committed a sin and I’ll never be forgiven?”
- Health: “What if I have a serious illness, even though I don’t have symptoms?”
- Perfectionism: “What if I don’t perform this task perfectly?” “I must be the best at everything, or else I’m a failure.”
- Sexual orientation: “What if I’m not really straight, and I’m just in denial?”
- Existential: “What if life is meaningless, and I’m wasting my time?” “I can’t stop thinking about death and what happens after it.”
What conditions involve intrusive thoughts?
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a mental health condition where intrusive thoughts often manifest as flashbacks, vivid memories, or distressing images of past trauma. These thoughts can occur at any moment, but especially if you’re reminded of your traumatic past.
Eating disorders
With eating disorders, it’s common to experience intrusive thoughts about food, body image, or weight. These thoughts can contribute to constant preoccupation with food choices, calorie counting, or comparing your body to others.
Anxiety disorders
Anxiety disorders like generalized anxiety disorder (GAD), social anxiety, and panic disorder can also involve intrusive thoughts. You may worry about worst-case scenarios, fears of losing control, or being judged by others.
Depression
Depression is a mental health condition that causes persistent feelings of sadness, hopelessness, and a loss of interest in activities that were once enjoyable. With depression, intrusive thoughts may take the form of self-criticism, fear of failure, or even thoughts about self-harm.
Psychosis
Psychosis is a condition that involves a disconnection from reality and can include symptoms such as delusions, hallucinations, and intrusive thoughts. Intrusive thoughts caused by psychosis might be accompanied by a loss of insight, making it difficult to recognize that the thoughts are not based in reality.
Obsessive-compulsive disorder (OCD)
OCD is a chronic mental health condition characterized by obsessions, which include recurrent and unwanted intrusive thoughts, feelings, urges, images, and sensations that cause distress. In response, people with OCD perform compulsions, which are repetitive behaviors or mental acts to reduce anxiety, neutralize a thought, or prevent something bad from happening.
Medications for dealing with intrusive thoughts
It’s important to note that people can respond to the same medication in different ways and may experience side effects—so, speak to your provider before taking a medication, and monitor any side-effects.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a class of medications that increase the availability of serotonin in the brain. Serotonin is a neurotransmitter that plays a key role in regulating mood, anxiety, and other emotional processes by improving communication between nerve cells in the brain.
SSRIs can reduce the intensity and frequency of intrusive thoughts by balancing chemical activity in the brain. These medications are commonly prescribed for depression, anxiety, and OCD—and about 40 to 60% of people who are prescribed SSRIs for OCD experience a partial reduction in their symptoms.
Some commonly prescribed SSRIs for OCD include:
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Celexa (citalopram)
- Lexapro (escitalopram)
Tricyclic antidepressants (TCAs)
TCAs work primarily by increasing the amount of norepinephrine and serotonin in the brain, boosting communication between cells. This can improve mood, and reduce symptoms of depression and anxiety. For people with OCD, TCAs can minimize the intensity and frequency of obsessions and compulsions. TCAs are typically prescribed if SSRIs aren’t effective.
The most commonly prescribed TCA for OCD is clomipramine (Anafranil).
Can medication make intrusive thoughts go away?
There’s no medication that can completely eliminate intrusive thoughts, says licensed therapist Tracie Ibrahim, MA, LMFT, CST, but some medications can help—especially when combined with exposure and response prevention (ERP).
Treating intrusive thoughts with ERP
Exposure and response prevention (ERP)
ERP therapy is a specialized form of cognitive behavioral therapy (CBT) specifically designed to treat OCD. ERP involves working with a therapist to gradually expose yourself to fears that trigger intrusive thoughts, and learning ways to resist compulsions. By learning to stop engaging in compulsions, you can break the cycle of OCD symptoms. Doing so helps reduce the power these thoughts have over you, which can cause them to feel less frequent and intense over time.
In ERP therapy, you’ll work with a therapist to face your fears and resist responding with compulsions, starting less challenging sounding fears, and working your way up—all while learning to sit with discomfort and uncertainty.
For example, if one of your intrusive thoughts is “What if I accidentally hurt someone I care about?” an early exercise might involve writing the thought down and sitting with it for a short period, without taking any actions to neutralize the thought. Eventually, you might progress to more challenging exercises, like imagining the situation in more detail or facing situations where you might feel more anxious or fearful of causing harm.
The goal is not to make the intrusive thought disappear but to reduce the reactions you have to in response, which in turn tends to lessen the frequency and intensity of the thoughts. Your therapist will work with you to create a curated, structured, personalized plan to address your unique experience with intrusive thoughts. In some cases, this plan can include medication.
ERP and medication for intrusive thoughts
It’s common for healthcare providers to prescribe medication to help manage the severity of OCD symptoms, including intrusive thoughts—especially if you’re also dealing with co-occurring mental health conditions like anxiety or depression that can make it especially hard to engage in ERP therapy. However, medication alone doesn’t teach you how to manage OCD symptoms. And, stopping medication can often cause symptoms to return.
ERP, on the other hand, addresses the root cause of OCD by targeting the cycle of obsessions and compulsions—providing more lasting relief. Medication can be a great supplement for ERP therapy, if your anxiety is making it difficult to get through ERP exercises.
When to see a professional
If you think intrusive thoughts are a result of a mental health condition, it’s important to seek professional help. A mental health professional can help you understand whether these thoughts are linked to a specific condition, like OCD. Getting a proper diagnosis is the first step for addressing the root cause of intrusive thoughts. From there, your provider can recommend a combination of therapy, medication, or other supportive strategies to help you manage intrusive thoughts.
It’s important to remember that what works for one person may not work for another, so finding the right balance of treatment methods, whether that’s medication or other therapies, is key. You don’t have to navigate it alone—support is available, and with the right strategies, it’s possible to manage your intrusive thoughts.