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One Less Obsession, One Less Compulsion

OCD Treatment

Updated 23-Jan-2016

NOTE: Before seeking treatment, look over the "First of All" section on my main OCD web page. Pay particular attention to the need for you to get some background on treating OCD for the purpose of determing whether a therapist or psychiatrist is knowledgeable about OCD and whether or not you will feel personally comfortable working with the OCD professional.

Behavior Therapy
Medicines
Neurosurgery
Brain Stimulation
Alternative Therapies

The International OCD Foundation (IOCDF) has several brief articles about treatment that may be useful to you. I also mention these on my "First of All" page, but I repeat the links here in case you're unable to dig into that page. As I say, the IOCDF articles are brief and, although not in-depth, will provide at least a cursory introduction to the different methods of treating OCD.

 

Behavior Therapy

Cognitive Behavioral Therapy (CBT) is probably the most effective form of treating most types of OCD. It can be done in conjunction with medication, although it is recommended that the patient be on a stable dosage throughout the treatment. The particular type of CBT used for OCD is called Exposure and Response Prevention (ERP). The therapist and the patient work together to draw up a list of the patient's obsessions, from least distressing to most distressing. Beginning with the least distressing obsession, the patient is exposed to the obsession and is prevented from responding to it with a compulsion. At first, the patient's anxiety level is extremely high after the exposure, but, gradually, after repeated exposures, the patient's distress decreases until he/she no longer feels the need to counteract the obsession with a compulsion. Once the CBT course is complete, the patient can use the techniques learned should old or new obsessions become distressing at a later date.

Behavior therapists are usually psychologists (Ph.D. or Psy.D.) or licensed clinical social workers (LCSW). It is important to choose a therapist (i) who has experience treating OCD with CBT and (ii) with whom you feel comfortable. The two articles below will help you know what to look for in a behavior therapist.

Should you be unable to make use of a behavior therapist (e.g., for OCD or financial reasons), there are self-help books available for building and working through your own course of CBT. Scan through this book list for examples of such books. Self-help requires some discipline, so you might ask a family member or close friend to help support you in the process.

Computer-Assisted Behavior Therapy

 

Medicines

Historically, drug therapy for OCD began with an old trycyclic antidepressant (TCA), clomipramine (brand name Anafranil) and, then, further experimentation with a different class of antidepressant drugs exploded into the use of Selective Serotonin Reuptake Inhibitors (SSRIs) for OCD, fluoxetine (brand name Prozac) being one of the earliest and most popular SSRIs. Serotonin is a neurotransmitter, a chemical released by a neuron to transmit a signal to the next neuron(s) in sequence. After the signal has been received, the serotonin is either taken back up by the first neuron or flushed out of your system. SSRIs inhibit the reuptake of serotonin into the first neuron. Despite years of research, it still not known why SSRIs affect depression and OCD; e.g., is there too much or too little serotonin?

SSRIs generally have fewer side effects than clomipramine. There are many SSRI brands and individual patients react differently (or don't react) to different SSRIs. Furthermore, it can take months to ramp up to a clinically significant level of dosage for a particular drug. Consequently, trying to find a drug that works for you can be a long, tedious process. In the end, you may or may not find such a drug. If you do find a drug that works, hopefully you're able to live with its side effects and hopefully its effect is not short-lived. (Spoken by someone for whom Zoloft magically worked for a year and then stopped working, never to work again, even years later.)

Fortunately, medications do help enough people with OCD to keep the industry and research active. Newer drugs that affect other neurotransmitters alone or in conjunction with serotonin have become available (e.g., Serotonin-Norepinephrine Reuptake Inhibitors or SNRIs). Atypical antipsychotics—seen all the TV commercials lately for Abilify?—are sometimes added to enhance the effect of an antidepressant. Read the two articles below about the many different drugs used to treat OCD.

Keep in mind, especially when considering drugs for children, that drugs have side effects. In my own family, the most common side effect was ravenous appetite coupled with severe weight gain. That and tiredness. Counseling self-discipline is not an option in the face of the drug's effects.

 

Neurosurgery

Neurosurgery is only considered for very, very, very serious cases of OCD.

 

Brain Stimulation

"How could I possibly be depressed after becoming a human transistor? I think I've finally found meaning and purpose in life."
- jczer68 on Digg

Seriously, these types of therapy should, at the moment, be classified as "Alternative Therapies". The effectiveness of the therapies remains to be seen. Deep Brain Stimulation and Vagus Nerve Stimulation require invasive surgery, reversible in both cases; alternate non-surgical methods of VNS are becoming available.

 

Alternative Therapies

Look before you leap! I'm leery of alternative therapies, hence my admonition. I much prefer the "evidence-based" methods such as psychopharmacology (a big word for drugs) and behavior therapy. That said, an individual may or may not find a drug that works for them; a course of behavior therapy may or may not be effective, possibly depending on the therapist you happened to choose. (A second admonition: Do your homework beforehand!) Consequently, trying alternative therapies is not out of the question. Simply the knowledge that you're doing something to alleviate your OCD may make it easier to live with. (Third admonition: Research safety precautions and drug interactions for dietary supplements and herbal medicines!)

Alex Measday  /  E-mail