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How is obsessive compulsive disorder treated in bipolar patients?

Obsessive compulsive disorder (OCD) plus bipolar disorder is, in my view, the psychopharmacologist's Mount Everest. When we have to use medications for OCD, the only ones that work very well are serotonin antidepressants (selective serotonin reuptake inhibitors [SSRIs] or Anafranil). Sometimes the atypical antipsychotics also can play a role. In order to avoid inducing manias, mixed states, and rapid cycling, we try to make as much progress as possible with a cognitive behavioral therapy called graded exposure and response prevention. In this therapy, one intentionally exposes oneself to stimuli that would ordinarily induce the desire to engage in a compulsion. Then one uses relaxation techniques to resist the urge to do the compulsion. Most patients find that if they do this, with lots of practice, they can ride out the urge to enact the compulsion and it passes. Similarly, a technique called thought stopping can be used to deal with obsessions.

However, there are lots of patients with bipolar disorder and OCD who also require medications. My personal approach is to be sure I have a rock stable mood by using mood stabilizers optimally, and then introducing Anafranil. One can also use other SSRIs, but my experience with them is that they are typically highly destabilizing for bipolar patients.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.