Although OCD was once thought of as difficult to treat, over two-thirds of people with OCD will respond well to treatment. The treatment of OCD includes medication, cognitive-behavioral therapy, surgery, and self-help strategies.
Medication
Medical treatment of OCD has focused on drugs called serotonin reuptake inhibitors (SSRIs). Well-known SSRIs include:
Anafranil (Clomipramine), a tricyclic antidepressant (named after its chemical structure), may also be used to treat OCD.
Although these medications are often called antidepressants, they are also very effective in treating anxiety disorders such as OCD. These drugs are thought to work by increasing the amount of serotonin that is available within the brain.
SSRIs can take up to 12 weeks to reduce your symptoms, so it is important that you consistently take your medication. If one type of SSRI does not prove beneficial, your physician may try another SSRI or augment it with other types of medications. Common side effects reported by people taking SSRIs are problems with sleep, and sexual side-effects. However, most individuals are able to tolerate these drugs without major difficulty.
Although more research is needed, some patients may benefit from the addition of an antipsychotic medication such as Risperdal (Respiridone), Zyprexa (Olanzapine) or Seroquel (Quetiapine) to their treatment plan.
Cognitive-Behavioral Therapy
Cognitive-behavioral techniques (CBT) have also proven highly effective in treating symptoms of OCD, as well as preventing relapse. CBT aims to fix the harmful patterns of thinking and behavior that often accompany OCD.
Exposure and response prevention (ERP) therapy, a form of CBT, may be particularly effective for OCD. In ERP therapy, a psychologist will help you gradually expose yourself to the specific obsessions or situations which provoke your anxiety. At the same time, you are taught ways to avoid using the ritual or compulsion that is normally used to reduce your anxiety. For example, you might practice touching a doorknob, which you fear is contaminated with germs, while at the same time resisting the urge to wash your hands again and again. This would be repeated many times until your anxiety about contamination is gone and handwashing is no longer disruptive to your life
Although exposure therapy is effective, it can be stressful as it requires that you face what you fear most. Unfortunately, 25% of people with OCD do not want to take part in behavioral therapy, and an additional 20% drop out of treatment once they have started. CBT also requires commitment and hard work. CBT is usually completed over 8 to 12 weeks in one-hour weekly sessions with a psychologist, and usually involves homework.
CBT works as well as medication and the effects may be longer-lasting, although a combination of CBT and medication may be the best treatment choice for some people. The decision to take a drug or to begin psychotherapy (or a combination of both) is a decision that can only be made by you, with the guidance of health professionals.
Self-Help
Self-help options can be used alone, or in combination with these other treatments. Numerous self-help books have been written on coping with OCD, and many of the books have been written from a cognitive behavioral perspective and may suggest homework assignments that are designed to help you manage your symptoms.
Additional self-help strategies include:
- Deep breathing or mindfulness meditation
- Regular exercise
- Keeping a daily journal
- Participation in activities or hobbies that provide a distraction
While self-help options can be helpful and are a good starting point for many individuals, the symptoms of OCD can be severe and usually require the assistance of qualified healthcare professionals.
Surgical Procedures
Surgery may be a last resort for the small number of people whose symptoms don’t improve after trying all currently available medical and/or cognitive-behavioral techniques. A very small minority of individuals with OCD have symptoms severe enough to consider brain surgery. Surgical procedures for OCD involve inactivating certain brain regions that are responsible for the symptoms associated with OCD. In most cases, approximately 50% to 70% of people who have these procedures see a significant improvement in symptoms.
Of course, as with any medical treatment, be sure to discuss potential side effects of brain surgery (such as personality change or neuropsychological changes) with your physician.
Deep-brain stimulation -- a new and exciting technique which has been effective in treating severe depression and Parkinson’s disease -- could hold promise for treating OCD. Deep-brain stimulation involves implanting an electrode in the brain which can turn different regions on and off. It is important to note that while there have been some promisising case reports for psychiatric illnesses, deep-brain stimultion is not yet an established treatment for any of mental illness including OCD.
Sources:
Larson, Paul. "Deep brain stimulation for psychiatric disorders". Neurotherapeutics January 2008 5: 50-58. 01 September 2008.
Schruers, K., Koning, K., Luermans, J., Haack, M. J., & Griez, E. "Obsessive-compulsive disorder: a critical review of therapeutic perspectives". Acta psychiatrica Scandinavica 15 February 2005 111:261-271. 01 September 2008.
