How is obsessive-compulsive disorder (OCD) treated?

Sudeepta Varma, MD
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.

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.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)

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.

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David Tolin

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.

31% reduction in symptom severity. 48% of patients considered responders. 19% of patients considered excellent responders. 45% relapse rate after treatment ended.

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.

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:

  • medication
  • psychological treatment

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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.