Treatment for OCD

Obsessive-compulsive disorder is treated most effectively by a combination of medication and cognitive behavioral therapy. Seven out of 10 people will respond to treatment. People who benefit from medication will usually see their OCD symptoms decrease by 40%-60%.

Medications used to treat OCD

Selective serontonin reuptake inhibitors (SSRIs) are a class of antidepressants that has been shown to be effective in the treatment of OCD. Not all antidepressants have a beneficial effect. Drugs including imipramine (Tofranil) and amitriptyline (Elavil) rarely improve OCD symptoms. On the other hand, positive results have been demonstrated by fluvoxamine (Luvox), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), fluoxetie (Prozac), paroxetine (Paxil), clomipramine (Anafranil), and venlafaxine (Effexor). These drugs work differently in each person due to individual brain chemistry, so it is important to work closely with your psychiatrist to find the best solution for you.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer class of antidepressants. They include venlafaxine (Effexor), desvenlafaxine (Pristiq and Khedezla), duloxetine (Cymbalta), and, levomilnacipran (Fetzima). Duloxetine (Cymbalta) has been very promising in the treatment of OCD that does not respond to SSRIs.

Anti-anxiety medications can be useful in addition to antidepressants in helping those with OCD. Anti-anxiety medications take the edge of stressful situations, making OCD symptoms less pronounced. But, anti-anxiety medications are not usually a replacement for antidepressant therapy.

Using psychotherapy to treat OCD

Clients with OCD benefit often from exposure and response prevention therapy (ERP), which is a form of cognitive behavioral therapy. 

Treating OCD in children and teens

Exposure and response therapy (ERT) is especially useful for children. Support groups are also helpful because OCD can make children and teens feel "different" and isolated from their peers. There are also support groups for the parents of children with OCD. ERP and medication together are considered the first line of defense against OCD. 

Medication should only be prescribed by a psychiatrist who has experience in working with children and teens because they often react differently to medication than adults. At this point, the FDA has approved four medications for use in children: clomipramine (Anafranil), fluoxetine (Prozac), fluvomaxine (Luvox), and sertraline (Zoloft). Other medications may be used off-label depending on the circumstances. For example, some children have difficulty swallowing pills, so a medication with a liquid form or other other version may be used.

About 70% of children and teens will respond to ERP combined with medication. However, it can take 3 months for improvements to be seen, so it is important to maintain treatment until it has a chance to work. During this period, work closely with your psychiatrist so that any side effects can be minimized. The doctor will also want to discuss symptoms to be sure they are abating.

Types of OCD

There are many types of obsessive-compulsive disorder. They are characterized by obsessive thoughts, compulsive (uncontrollable) behaviors, or a combination of both. 

Pure obsessional (pure-O)

The individual has unwanted thoughts but no associated outward behaviors.  Thoughts are usually sexual, violent or otherwise taboo in nature. The person may engage in mental compulsions, such as prayer, to find relief. Some people may be obsessively worried about their sexual orientation and seek constant reassurance or avoid others altogethers.

Hoarding

Individuals hoard items without value under the belief they "may be needed someday."

Scrupulosity

The obsessive fear of "being bad" leads to ongoing feelings of generalized guilt and the reciting of prayers, seeking forgiveness, or engaging in religious rituals.

Symmetry and exactness

People with this form of OCD arrange objects in order to gain a feeling of control. Magical thinking can be associated with this form of OCD. 

Causing harm by accident

This form of OCD features the excessive checking of doors, stoves, appliances, etc. or constant reassurance from others. These people are obsessed with the idea they will accidentally "burn the house down," make a mistake, or offend someone. Driving, especially at night, may be avoided for fear of hitting a person or animal.

Contamination fears

People with this form of OCD are afraid they will get sick or otherwise experience harm by touching surfaces such as door knobs and bed sheets or by touching others (such as handshaking). These fears lead to excessive hand-washing or bathing, avoiding touching others, or wearing gloves and masks.

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