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Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for obsessive-compulsive disorder (OCD). While some patients respond better to one SSRI than to another, their symptoms usually don't disappear completely. Often, they're cut by less than half. Therefore, many people need to combine an SSRI with another drug, such as a tricyclic antidepressant or benzodiazepine, or with cognitive behavioral therapy (CBT) or exposure therapy. The combination of SSRIs and therapy is often more effective than either used alone. In more severe cases, inpatient treatment in a psychiatric unit that specializes in OCD treatment may be necessary.
In very rare cases and as a last resort, neurosurgery can be performed on people who don't respond to medications or to behavioral therapy. Such procedures aim to sever some of the brain circuitry from the basal ganglia, which is thought to influence repetitive, ritual behavior. Only a few medical centers perform this procedure, and it's too early to know the long-term outcomes.
Obsessive compulsive disorder, or OCD, is an anxiety disorder that affects about 3% of the population in the United States. When most people hear the term "OCD" they often think of the stereotypes such as people washing their hands excessively throughout the day, being fearful of germs, having to engage in repetitive acts such as checking to make sure they locked the front door or turned off the stove, and so on.
When people have compulsions such as those mentioned above, the traditional treatment used is cognitive-behavior therapy (CBT), a treatment that combines looking at a person's thinking patterns with exposure therapy - having the patient expose herself to the feared stimulus without engaging in the compulsions she would normally use to reduce her anxiety. In other words, a therapist would have a client not wash her hands when she felt the need, and over time, the client learns to tolerate the anxiety this generates so that she can eventually stop herself from engaging in the compulsive behavior.
A less common type of OCD, however, involves more obsessional thoughts rather than compulsions. This is sometimes called "Pure O", and the people suffering from these obsessional thoughts can be quite tormented by them. I've worked with clients who have had thoughts that they are going to kill or otherwise harm their family; that they are going to act sexually inappropriately; that they have done something "wrong" or "bad" that they have no memory of, and so on. Because in this type of OCD there may not be an overt compulsion that the person is acting on, and that we can therefore do exposure therapy with, it tends to be more difficult to treat. When this is the case, then, we still use CBT as much as it applies, but we also use another technique called Mindfulness (this is a helpful technique in treating OCD in general).
In his book Brain Lock, Jeffrey Schwartz describes OCD as causing the brain to act like a car's gear shift that gets stuck - essentially, he says, the brain gets stuck in gear and can't shift out of that OCD thought. He then goes on to describe how to use mindfulness to get the brain unstuck, in order to treat both obsessive thoughts and compulsions.
Although often portrayed as a humorous illness (e.g. As Good as it Gets, Monk) it's important to realize that OCD can be debilitating and that individuals with this illness really do suffer.
Specific treatment for OCD will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment may include:
- psychological treatment
Treatment of obsessive compulsive disorder (OCD) relies on therapy or a combination of two therapies. "One is medication, typically SSRIs, or selective serotonin reuptake inhibitor antidepressants," says Dr. David Tolin, director of the Anxiety Disorders Center at the Institute of Living. "The other is a form of counseling called cognitive behavior therapy, where we use a process called exposure." Exposure involves putting the OCD patient in repeated contact with the feared stimulus. Over time, this process helps diminish the anxiety related to the fear, of germs for example.
Response prevention is also an important component, which involves teaching the patient not to engage in their typical obsessive rituals, such as constant washing to remove suspected dirt.
This content originally appeared on doctoroz.com
Obsessive-compulsive disorder (OCD) is usually treated with a combination of psychotherapy and medication management. In this video, psychiatrist Sue Varma, MD, discusses how cognitive behavioral therapy and SSRI medications can work to treat OCD.
There are several treatments that can help manage OCD, including psychological treatments such as cognitive behavioral therapy (CBT) and certain antidepressant medications. The goal of CBT is to identify and change the thoughts and beliefs that are at the root of the compulsive behavior. Another type of behavioral therapy, known as exposure therapy, focuses on substituting positive behavioral responses when a person is triggered by compulsive behaviors. Medications for OCD include selective serotonin reuptake inhibitors including paroxetine, fluoxetine, and fluvoxamine, and a tricyclic antidepressant called clomipramine.
In this video, Wayne Goodman, MD, chairman of the Department of Psychiatry at the Mount Sinai School of Medicine, discusses both therapies.
By treating the infections and eliminating the food allergies, while repairing the gut, we reduce the inflammation in the brain. Then we combine much needed nutrients, one supplement for OCD (Inositol), and one hormone with a behavioral therapy (exposure and response prevention).
The standard approach to OCD (medication and exposure and response prevention therapy) leaves many individuals only partially treated and with short and long term side effects, and metabolic consequences that affect long term health (diabetes, osteoporosis, metabolic syndrome).
The links between the immune system and OCD are many. One important link, which goes beyond the very specific PANDAS syndrome, is the fact that infection or inflammation anywhere in the body causes changes in the brain’s ability to make serotonin. In this scenario, cytokines (hormones of the immune system) activate an enzyme (IDO) in the brain, which takes tryptophan, and instead of making serotonin from it, makes something called kyneurenin and quinolinic acid.
These cause increases in dopamine (as serotonin goes down, dopamine goes up, which increases tics and stereotypical behaviors) and activation of excitatory pathways (NMDA/glutamate) leading to anxiety. Thus the immune inflammatory pathways are critical pathways in the genesis of the OCD. Medications are only partially effective, as they do not address this aspect of the disorder.
In the largest comparative treatment study to date, published in 2005 in the American Journal of Psychiatry, 149 patients with OCD were randomly assigned to receive various treatments. These included exposure and response prevention, which means gradually facing scary things combined with strict instructions to abstain from compulsive safety behaviors. So, for example, someone with obsessive fears of contamination and a pattern of compulsive hand-washing would be instructed to touch progressively dirtier and dirtier things, while refraining from all washing or cleaning behaviors (compulsions). Another group received the antidepressant clomipramine, which is a well-established medication for treating OCD, over an equivalent period of time. Another group received both treatments in combination.
Results were as follows:
Exposure and response prevention: 55% reduction in symptom severity. 86% of patients considered responders. 57% of patients considered excellent responders. 11% relapse rate after treatment ended.
Clomipramine: 31% reduction in symptom severity. 48% of patients considered responders. 19% of patients considered excellent responders. 45% relapse rate after treatment ended.
Both: 59% reduction in symptom severity. 79% of patients considered responders. 47% of patients considered excellent responders. 14% relapse rate after treatment ended.
Conclusion: Exposure and response prevention is effective for treating OCD, and appears more effective than clomipramine in the short-term and particularly after treatment ends. Combining medications plus therapy does not appear to yield a large advantage over the therapy alone.
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.