Treating OCD with Medication
Obsessive compulsive disorder (OCD) is a mental health condition characterized by obsessions (recurring, repeated, unwanted thoughts) and compulsions (drives to complete tasks repeatedly). The compulsions are often activities that will, temporarily, relieve the obsessive thoughts. The obsessive thoughts do, however, return, and then the cycle continues.
Some people experience obsessions or compulsions without it being considered OCD, such as the desire to keep your room tidy or wash your hands after touching a public doorknob. However, it’s not characterized as OCD unless these obsessions and compulsions are repeated, cause distress and interfere with your life. The distress can come from the urgency of the obsessions and compulsions, or most commonly, can appear if something gets in the way of you completing your compulsions.
Many people with OCD know that their obsessions are not realistic or actually “necessary”, but as completing the compulsion is able to provide temporary relief from the obsession, it’s often easier to “play along” rather than fight the thoughts.
Difference Between OCD and Anxiety
OCD is considered to be a kind of anxiety disorder. Anxiety, specifically generalized anxiety disorder (GAD), is characterized by excessive worries about multiple things nearly every day. It can cause distress and interfere with daily functioning due to the avoidance and intensity of the worry that often comes with anxiety.
However, the main difference between GAD and OCD is the presence of compulsions in OCD. Both disorders are characterized by unwanted fears or urges, but OCD has the characteristic need to neutralize those thoughts with compulsions.
GAD is also characteristic of multiple different worries, while OCD can be just one worry as long as the worry is causing distress and requiring compulsions to alleviate it.
How is OCD Diagnosed?
To get diagnosed with OCD, you must speak with a registered healthcare provider such as a medical doctor. Your healthcare provider will then rule out any other medical conditions or substances that could be causing your symptoms.
could be causing your symptoms. Once any other factors are ruled out, your healthcare provider will discuss your symptoms and determine if you meet the diagnostic criteria for OCD.
To meet the criteria for OCD, you must experience both obsessions and compulsions as defined by:
- Intrusive and unwanted, recurrent, persistent thoughts, urges, or images that are experiences, usually causing anxiety or distress.
- An attempt to ignore the thoughts or to make them go away by performing a thought or action (compulsions).
- Repetitive behaviours, physical or mental, that you feel driven to perform in response to an obsession.
- These behaviours are completed in order to neutralize the obsessions and relieve anxiety or are performed in order to prevent an unrealistic consequence of not completing the compulsion.
The obsessions and compulsions must also be time consuming, taking up at least 1 hour of each day and/or cause impairment to social, occupational, educational, and/or other areas of functioning.
The obsessive thoughts must also not be better explained by another mental illness, health condition, or substance.
Treatment Options for OCD
- Cognitive behavioural therapy (CBT)
This type of therapy focuses on changing your thought processes and resulting reactions. By training yourself to redirect your thoughts, you may be able to calm down the obsessions and decrease the need to complete compulsions.
- Exposure and response prevention (ERP)
This is a type of CBT specifically formulated for OCD. This type of therapy focuses on exposure to the thoughts, images, and urges associated with OCD obsessions. This is the “exposure” part of ERP. The “response” component then refers to the part of this therapy where you make the choice not to participate in the compulsions. This is to be done with the guidance of a trained professional. It will be difficult at first but should get easier over time hopefully to the point where you no longer feel the need to perform the neutralizing compulsions.
OCD is a mental health condition that frequently requires medication treatment. The medication is sometimes just used to calm the brain down and therefore let you work away from your obsessions and compulsions. Sometimes, however, it can be indefinite, and you may remain medicated as long as you and your healthcare provider see fit.
The main medications approved for OCD treatment are antidepressants. The first-line options are SSRIs, while the second options are TCAs. You may need to try a few different medications before you find the one that works best for your needs.
The medications that work for OCD typically act on increasing serotonin (the “happy” chemical). This is because OCD is thought to be at least partially caused or aggravated by low serotonin levels in the brain. Serotonin is involved in communication in your brain, and it’s thought that decreased serotonin may contribute to the mismatched thought processes of OCD. Increasing serotonin may improve the communication and therefore help relieve the symptoms of OCD.
The medications approved to treat OCD include:
- Selective serotonin reuptake inhibitors (SSRIs)
- SSRIs work by decreasing the reuptake (removal) of serotonin from your body. Stopping the reuptake allows serotonin to stay around for longer and therefore be able to help improve the OCD symptoms.
- The SSRIs approved for OCD include sertraline, fluoxetine, fluvoxamine, and paroxetine.
- Tricyclic antidepressants (TCAs)
- TCAs work by inhibiting the reuptake of both serotonin and norepinephrine (an excitatory chemical). It is thought that the main benefit of this medication is the increase in serotonin, but it is also possible that norepinephrine has an additional effect.
- The only TCS approved to treat OCD is clomipramine.
When you think your loved one has OCD
OCD is a very difficult mental illness. It is difficult for the one experiencing it, but also can have a large impact on family and friends. The strict behaviours and distressing thoughts of those with OCD can be a major point of contention with loved ones. However, it’s important to not get angry with those experiencing this difficult mental health condition. People with OCD don’t want to have these obsessions and do not want to partake in their compulsions, but it’s very distressing when they cannot.
To help a loved one experiencing OCD, encourage them to speak to their healthcare provider about possible treatment options. There are many options for treatment, and there will be one to fit anyone’s various needs.
- Drugs@FDA: FDA-Approved Drugs. (2022). Retrieved 27 July 2022, from https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
- Baumgarten HG, Grozdanovic Z. Role of serotonin in obsessive-compulsive disorder. Br J Psychiatry Suppl. 1998;(35):13-20. PMID: 9829022.
- International OCD Foundation | Exposure and Response Prevention (ERP). (2022). Retrieved 29 July 2022, from https://iocdf.org
- Crazy Talk: How Is OCD Different from Generalized Anxiety?. (2022). Retrieved 29 July 2022, from https://www.healthline.com
- Clinical Definition (DSM-5) of Obsessive Compulsive Disorder (OCD). (2022). Retrieved 29 July 2022, from https://beyondocd.org
- Treatment - Obsessive compulsive disorder (OCD). (2022). Retrieved 29 July 2022, from https://www.nhs.uk
- Obsessive-compulsive disorder (OCD) - Diagnosis and treatment - Mayo Clinic. (2022). Retrieved 29 July 2022, from https://www.mayoclinic.org
- OCD (Obsessive-Compulsive Disorder) - PsychGuides.com. (2022). Retrieved 29 July 2022, from https://www.psychguides.com.
- National Collaborating Centre for Mental Health (UK). Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. Leicester (UK): British Psychological Society (UK); 2006. (NICE Clinical Guidelines, No. 31.) 6, PHARMACOLOGICAL INTERVENTIONS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK56455/
- Brock H, Hany M. Obsessive-Compulsive Disorder. [Updated 2022 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553162/