Stress Management

Obsessive-Compulsive Disorder (OCD)

Treatments for OCD

Medications and behavioral treatments can benefit people with OCD. A combination of the two treatments is often helpful for most patients. Some individuals respond best to one therapy, some to another.

Pharmacotherapy

Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. The first of these serotonin reuptake inhibitors (SRIs) specifically approved for the use in the treatment of OCD was the tricyclic antidepressant clomipramine (Anafranil). It was followed by other SRIs that are called "selective serotonin reuptake inhibitors" (SSRIs). Those that have been approved by the Food and Drug Administration for the treatment of OCD are flouxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil). Another that has been studied in controlled clinical trials is sertraline (Zoloft).

Large studies have shown that more than three-quarters of patients are helped by these medications at least a little. And in more than half of patients, medications relieve symptoms of OCD by diminishing the frequency and intensity of the obsessions and compulsions. Improvement usually takes at least three weeks or longer. If a patient does not respond well to one of these medications, or has unacceptable side effects, another SRI may give a better response.

Dr. Shila Mathew, M.D., a board certified psychiatrist and cofounder and Medical Director of holisticonline.com, stated that the first-line treatments for OCD is antidepressants, especially SSRIs. However, these often give severe side effects to the patients. These may include sleeplessness (insomnia), sexual dysfunction, nausea, weight gain, etc. When the patents are given SSRI and trazadone, it was more effective and the patients' side effects, especially insomnia, improved.

Dr. Mathew said that there is considerable evidence that trazodone may have antiobsessive properties. In one early investigation, trazodone reduced the obsessive symptoms in a single patient by 40% and that the improvement lasted for 5 months. Another study showed that six of 10 patients with OCD improved significantly after 10 weeks of treatment with trazodone. In another study, eight of 10 OCD patients showed an improvement with trazodone.

Trazodone appears to be particularly effective in reducing the side effects produced by SSRIs, such as nausea, gastrointestinal distress, anxiety, sleep disturbances, weight gain, and sexual dysfunction. Resolution of these symptoms occurred quite rapidly in all SSRI-treated patients in whom trazodone augmentation was added. Trazodone is very tolerable and is useful addition to long-term therapy with an SSRI, such as is commonly necessary for OCD patients.

Medications are of help in controlling the symptoms of OCD. But, if the medication is discontinued, often a relapse will follow. Indeed, even after symptoms have subsided, most people will need to continue with medication indefinitely, perhaps with a lowered dosage.

Behavior Therapy

Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient is deliberately and voluntarily exposed to the feared object or idea, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand washer may be urged to touch an object believed to be contaminated, and then may be denied the opportunity to wash for several hours. When the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time.

Studies of behavior therapy for OCD have found it to produce long-lasting benefits. To achieve the best results, a combination of factors is necessary: The therapist should be well trained in the specific method developed; the patient must be highly motivated and have a positive, determined attitude; and the patient's family must be cooperative. In addition to visits to the therapist, the patient must be faithful in fulfilling "homework assignments." For those patients who complete the course of treatment, the improvements can be significant.

The positive effects of behavior therapy endure once treatment has ended. A compilation of outcome studies indicated that, of more than 300 OCD patients who were treated by exposure and response prevention, an average of 76 percent still showed clinically significant relief from 3 months to 6 years after treatment. Another study has found that incorporating relapse-prevention components in the treatment program, including follow-up sessions after the intensive therapy, contributes to the maintenance of improvement.

One study provides new evidence that cognitive-behavioral therapy may also prove effective for OCD. This variant of behavior therapy emphasizes changing the OCD sufferer's beliefs and thinking patterns.

With a combination of pharmacotherapy and behavioral therapy, the majority of OCD patients will be able to function well in both their work and social lives. 

Source: NIMH

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