How Is OCD Treated?
OCD is typically treated with a combination of medications and therapy. A medical doctor or nurse practioner can prescribe medications, and a psychologist, therapist, psychiatrist or counselor can provide psychotherapy.
Medications
The most common medications prescribed to treat OCD are as follows:
- Selective serotonin reuptake inhibitors (SSRI's):
This class of medication is used to treat depression, anxiety and OCD. People with OCD often require a higher doseage. The most common side effects are gastrointestinal upset, sexual dysfunction, and sleepiness or sleep distrubances. Examples include: Prozac (the generic is fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Luvox (the generic is fluvoxamine; brand-name Luvox is actually no longer available), Celexa (citalopram) and Lexapro (escitalopram).
- Serotonin and norepinephrine reuptake inhibitors (SNRI's):
This class of medications is also used to treat depression, anxiety and OCD. Potential side effects are similar to those of the SSRI's, although elevated blood pressure is possible as well. The two SNRI's currently available are: Effexor (venlafaxine) and Cymbalta (duloxetine).
- Anafranil (the generic is clomipramine):
This is an older "tricyclic" antidepressant, and its side effects are similar to those of SSRI's, but can also include dry mouth and heart arrhythmias.
- "Off-label" medications:
The following medications are sometimes used to treat OCD, even though they are not officially approved by the FDA:
- Benzodiazepines, a class of antianxiety medications, which include: Valium (diazepam), Klonipin (clonazepam), Ativan (lorazepam) and Xanax (alprazolam).
- Mood stabilizers, like lithium, Depakote or Tegretol.
- Atypical antipsychotics, which are also used to treat schizophrenia and bipolar disorder, and include the following: Seroquel (quetiapine), Zyprexa (olanzapine), Geodon (ziprasidone), Abilify (aripiprazole), Risperdal (risperidone) and Invega (paliperidone).
Psychotherapy
Psychotherapy, or "talk therapy," is usually focused on behavioral techniques, which include the following:
- Exposure and Response Prevention:
Example: A person with OCD is obsessed with symmetry, and compulsively rearranges their desk over and over again. The therapist "exposes" her to a very messy, cluttered desk, which she must then tolerate. She is "prevented from responding" in her usual way (which would be to clean up the desk), and instead must cope with her discomfort until it passes.
- Relaxation: In the same example above, the person with OCD could also be coached on deep breathing or meditation as ways to get through the discomfort.
- Systematic Desensitization: The therapist constructs a "hierarchy" of distressing scenarios for the person with OCD to tackle.
For example, the person with OCD is preoccupied with germs and hand-washing. The therapist might start by having the person imagine that their hands are a little dirty, and gradually works up to having the person touch a public toilet seat.
- Flooding: In this technique, ther person with OCD is exposed to her "worst nightmare," as a means to overcome their fears more quickly. In the above example, the person with OCD would first have to touch the toilet seat.
Hospitalization
A few people with OCD have such severe symptoms that they are literally unable to function. Their obsessive thinking and ritualistic behaviors take up so much time and energy that they are unable to work, sleep or take care of themselves. In such cases, inpatient hospitalization may be necessary to make sure that the person is safe, and to treat them more aggressively than would otherwise be possible.
Electroconvulsive Therapy
In some severe cases of OCD, electroconvulsive therapy (ECT, or "shock therapy") may be used.
Surgery
In rare cases of extremely severe OCD, when a person has not responded to any other treatments, brain surgery may be performed. The surgery is called a cingulotomy and involves a neurosurgeon removing a part of the brain called the cingulate. While this surgery results in lessened OCD symptoms some people, it can also cause seizures to develop.
Sources:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Sadock, Benjamin J and Sadock, Virginia A. Synopsis of Psychiatry, Ninth Edition. Philadelphia: Lippincott, Williams & Wilkins, 2003.