Why Isn't My Treatment for OCD Working?

Question: Why Isn't My Treatment for OCD Working?

Although many FDA-approved treatments for OCDare available, roughly one-third of people’s symptoms do not respond or respond only partially after taking them. Let’s look at some reasons why your treatment for OCD may not be working and what to do about it.

Answer: Not all medications work equally well for everybody. You and your psychiatrist may have to try switching medications or trying many different combinations of medications before you settle on a treatment that works for you. Unfortunately, this can sometimes take months of experimentation. Although frustrating, it is important to stick with the program so that your doctor can accurately evaluate how a particular drug is working for you.

Because of your genetics, other prescription medications you're taking, or the use of alcohol or drugs, you may absorb/metabolize drugs differently than other people. This may also be contributing to the medications level of effectiveness. A blood test may be used to see how much medication is actually in your system. In addition, you should note that herbal therapies such as St. John’s Wort can also change the way prescription drugs are processed by your body. Always consult your family doctor or psychiatrist before beginning an herbal remedy.

Many of the medications prescribed for OCD take 4 to 8 weeks to start working. A drug is unlikely to improve your symptoms if you stop taking it too early. On the flip side, if you have had a positive result from taking a drug but then stop it, your symptoms may return. Never stop taking a medication without consulting your doctor.

In order for medications to work, they need to be taken at the correct dose. For example, the correct dose for treating OCD with SSRIs is often much higher than when treating major depression. In certain cases, your doctor may even prescribe a dose higher than indicated by the drug manufacturer. In addition, you may need to take the drug for longer than someone being treated for depression. If you have questions about your drug dosage, be sure to consult with your doctor. It is very important to not change the dosage of your medication on your own.

Most drugs need to be taken consistently to work. Skipping doses or regularly forgetting to take your medication may also reduce its effectiveness. Always follow the instructions for taking your medication.

The treatment you receive is usually based on the diagnosis made by your family doctor, psychiatrist or psychologist. If your diagnosis is incorrect, it could increase the chance of receiving a treatment that is ineffective in treating your symptoms. In addition, there is some evidence that particular OCD symptom subtypes may respond better to one form of therapy over another. For example, while hoarding does not seem to respond well to treatment with medication, psychotherapy can often be helpful. If you have concerns about your diagnosis or the treatment of your specific symptoms, talk to your doctor

_Sources:

Ipser, J.C., Carey, P., Dhansay, Y., Fakier, N., Seedat, S., & Stein, D.J. "Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders." Cochrane Database Systematic Review 2006 Oct 18;CD005473.

Walsh, K.H., McDougle, C.J. "Pharmacological augmentation strategies for treatment-resistant obsessive-compulsive disorder. Expert Opinion in Pharmacotherapy 2004 5:2059-67.