Obsessive-Compulsive Disorder (OCD)
Treatment Overview
The earlier you seek treatment for obsessive-compulsive disorder (OCD), the better. Early treatment of OCD can reduce symptoms and reduce the disruption the illness can create in your life. Unfortunately, research shows that most people see an average of 3 to 4 health professionals and spend more than 9 years seeking treatment for OCD before they are correctly diagnosed.6 Their diagnoses are complicated by their being embarrassed or secretive about their symptoms and by other conditions they may have along with OCD, such as depression.
Treatment includes a combination of professional counseling and medicines.
Initial treatment
Depending on the severity of your symptoms, your doctor may prescribe only counseling or counseling and an antidepressant, such as fluoxetine (for example, Prozac), fluvoxamine (Luvox), or sertraline (Zoloft). For severely ill people who cannot function in a job or in social situations because of their symptoms, it is recommended that medicines be tried first before counseling.6
- Counseling:
A type of cognitive-behavioral therapy called exposure and response prevention is considered the most effective type of counseling for OCD.6 With exposure and response prevention therapy, you repeatedly expose yourself to an obsession, such as something you fear is contaminated, and deny yourself the ritual compulsive act, which in this case would be washing your hands. This therapy is done with a therapist or on your own with direction from your therapist.
In the beginning of exposure and response prevention therapy, your therapist may ask you to write a list of your obsessions, rituals (compulsions), and things that you avoid and then have you rank the amount of anxiety each of the obsessions causes from highest to lowest. You might begin exposing yourself to an obsession that causes a moderate amount of anxiety and then work your way up the list to the obsession that causes the most anxiety.
Therapists often combine exposure and response prevention therapy with cognitive-behavioral therapy to help overcome the faulty beliefs (such as fear of contamination) that lead to OCD behaviors.
- Medicines
Your doctor may first prescribe an antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (for example, Prozac), or a tricyclic antidepressant, such as clomipramine. You may start to feel better within 1 to 3 weeks of taking an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor. Your doctor may increase the dosage of your medicine or change to another SSRI if the first medicine prescribed doesn't help.
Ongoing treatment
Ongoing treatment for OCD includes monitoring the dosage and effectiveness of your medicines. Your doctor may want you to stay on one medicine for at least 10 to 12 weeks before trying a different antidepressant. Although antidepressants are considered the most effective medicine for OCD, researchers are studying whether other medicines, such as dopamine antagonists, can be combined with antidepressants for better results.
If you are in counseling, your doctor will monitor your progress and, if necessary, modify the amount or type of counseling you're receiving. Research shows that those who receive the most counseling have the best results and that longer sessions (at least 90 minutes) of exposure and response prevention therapy are more effective for reducing anxiety than short sessions.6 Between 13 and 20 sessions may be needed to relieve symptoms. Your health professional may also advise family members to participate in therapy with you or on their own.
Treatment if the condition gets worse
Deep brain stimulation, which uses surgically implanted electrodes in the brain, and magnetic stimulation of parts of the brain may be tried in rare cases when other treatment has not been successful.
What To Think About
Consistency is important for both counseling and medicines. People who don't take their medicines regularly or stop altogether often have their symptoms return (relapse). With therapy, it is important to work with your health professional to determine when, or if, you should stop.
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| Author: | Sabra L. Katz-Wise | Last Updated: July 27, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry | |
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