Treating Obsessive-Compulsive Disorder: OCD Medication and Therapy

Learn the pros and cons of using medication and/or OCD-specific therapy to treat symptoms of obsessive-compulsive disorder.

Rorshach test, representing OCD treatment, including therapy or medication options

Once the symptoms of OCD have been accurately diagnosed, it’s important to start treatment as early as possible. If ignored, OCD symptoms can grow stronger and interfere more and more with daily life.

Like most mental health disorders, OCD is nearly impossible to “cure” — meaning symptoms may never go away completely. However, it is highly treatable, and many patients can reduce symptoms to tolerable levels so they no longer interfere with day-to-day activities and relationships.

OCD is most commonly treated with a specific type of psychotherapy known as Exposure and Response Prevention therapy, or ERP. However, medication is often used in conjunction with therapy to more effectively control symptoms and make up for gaps in treatment.

ERP Therapy

In most cases, ERP has been found to be just as effective — and in some instances more effective — than medication. ERP is a specific type of therapy that forces patients to confront the obsessive thoughts, images, objects, or situations that make them anxious. In an uncontrolled environment, the patient would temporarily alleviate the anxiety caused by the obsession with some compulsive behavior. In ERP, the therapist stops them from carrying out the compulsion.

A common example of this relates to contamination obsessions. Someone obsessed with the idea of germs, for example, may wash their hands repeatedly. An ERP therapist may start their treatment by asking them to touch the bottom of a dirty shoe, and then prohibiting them from washing their hands for an hour. Once that milestone is conquered, the therapist may work up to having the person touch a dirty toilet seat or something else far outside their comfort zone.

During ERP therapy, a patient’s anxiety typically rises — and then, eventually, it goes back down. The human body isn’t designed to maintain a high level of anxiety for a long period of time, so over time the person adjusts to the anxiety and it feels less and less severe.

When a person with OCD carries out their compulsion, they think they’re reducing their anxiety, but in reality they’re actually just pushing it back down. And if it’s simply pushed under the surface, it will resurface — in most cases, stronger than before. But when the patient is compelled to sit with an uncomfortable level of anxiety, and resist the temptation to push it back under the surface, they learn to confront it and see that their anxiety can be controlled in a healthy way.

Many ERP therapists get creative when addresses patients’ obsessions. If a patient is obsessed with her mother developing breast cancer — and avoids anything with the word “cancer” in it as a result — the therapist might ask her to write a short play where her mother develops breast cancer. While writing and acting out this play with her therapist, she would be unable to avoid her taboo word. With time, the patient would become habituated to the level of anxiety that the obsession creates, and learn how to deal with it in a healthy way.

“The power of an OCD thought comes in the intrusion, and it comes in the avoidance,” says Roberto Olivardia, Ph.D., a clinical psychologist who specializes in the treatment of OCD at McLean Hospital in Boston. “So the more one avoids and the more one pushes that thought away, it’s actually giving the very power to the thought.” ERP therapy takes that power away from the obsessive thought, by forcing the patient to confront it head on.

Cognitive Behavioral Therapy

Cognitive behavioral therapy has also been used to treat OCD, though the results are far less promising than are those for ERP. Essentially, CBT works to confront the thoughts behind the OCD and identify where they’re irrational. This can be especially useful in cases where the person is unsure if their fears and anxieties related to OCD are in fact irrational. However, for CBT to be successful, it most often needs to be combined with the behavioral component of ERP.

Medication

Since ERP results take time — and not all symptoms can be fully controlled with therapy — many doctors also prescribe medication to help keep OCD symptoms at tolerable levels.

Obsessive-compulsive disorder is thought to be linked to deficiencies in serotonin, so the psychopharmacological treatment of choice is often an antidepressant. While doctors usually start with a Selective Serotonin Reuptake Inhibitor (SSRI) like fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), or sertraline (Zoloft), they can also try a tricyclic antidepressant like clomipramine (Anafranil). Both types of antidepressants have shown to be effective in treating OCD symptoms like rigid thoughts and repetitive behaviors.

Like all psychiatric medications, OCD medications have potential side effects that include:

- Upset stomach
- Sleep disturbance
- Sweating
- Decreased libido
- Increased risk of suicidal thoughts. Though rare, this side effect is serious — particularly for teenagers and young adults. If suicidal thoughts occur, contact a doctor immediately.

A word of warning: stimulant medications used to treat ADHD have been shown to make OCD symptoms worse — particularly if the patient suffers from compulsive hair and skin picking. It’s important to tease out both diagnoses before prescribing medication — in these cases, it may be best to treat the OCD with antidepressants and focus on behavioral therapy for the ADHD.

TAGS: OCD, Comorbid Conditions with ADD, ADHD Stimulant Medications

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