The treatment of obsessive compulsive disorder (OCD) depends on the severity of the condition. This is determined by the degree of impact the condition has on a person’s ability to function normally on a day-to-day basis.
How much the condition impairs daily function depends on how much time is taken up with obsessive thoughts or compulsive behavior. The degree of functional impairment seen in OCD can be divided into the following levels of severity:
- Severe functional impairment - The obsessive thoughts and compulsive behavior occupy more than three hours of the patient’s day
- Moderate functional impairment - The thoughts and behavior occupy one to three hours a day
- Mild functional impairment - The thoughts and behavior occupy less than one hour a day
Treatment usually involves a combination of medication and behavioral therapy. For those with mild functional impairment, cognitive behavioural therapy (CBT) is the main treatment approach. CBT is a form of talking therapy that helps the patient understand and change the way they think or behave.
People with moderate functional impairment may require a more intensive course of CBT or may be prescribed antidepressants called selective serotonin reuptake inhibitors (SSRIs). People with severe functional impairment are referred to a specialist who usually prescribes a combination of intensive CBT and SSRI therapy.
Cognitive behavioral therapy for OCD
CBT that involves a method called exposure and response prevention (ERP) has been identified as successful in helping people with OCD.
ERP involves identifying situations that may give rise to the patient’s anxiety and then developing tasks that the patient can carry out where they are exposed to these situations at a level they can cope with. The patient practices the tasks without carrying out the compulsive behavior that usually relieves the anxiety. The patient repeats the task several times a day until the anxiety associated with the task reduces and eventually disappears. They may then move onto another of the tasks identified as causing anxiety.
People with mild OCD usually need about 10 hours of therapy, with exercises completed by the patient in between. Those with moderate or severe OCD may require a more intensive course of CBT.
Medications for OCD
In cases where CBT fails to help a person with mild OCD or if a patient has a more severe form of the condition, then antidepressant medications such as SSRIs may be prescribed. SSRIs increase levels of a chemical called serotonin in the brain.
Serotonin is a chemical messenger that transmits information between brain cells. Commonly prescribed SSRIs include fluoxetine, fluvoxamine, paroxetine, citalopram, escitalopram and sertraline. These drugs usually take around 12 weeks to produce beneficial effects and people with moderate-to-severe OCD usually need to take them for at least one year. After a patient has been taking the SSRIs for one year, they are reviewed to see if they can be taken off the medication.
Some of the common side effects of SSRIs include headaches, nausea and sleepiness. Some patients may also experience an increase in anxiety that leads to suicidal thoughts or urges to self-harm. Physicians treating patients with OCD need to be aware of this and a friend or family member who will keep a close eye on the patient may be included in the therapy sessions.
An alternative drug that may be prescribed is clomipramine, a tricyclic antidepressant. Tricyclic antidepressants are not prescribed as often as SSRIs because they are associated with more side effects. However, they can be useful in cases where patients do not tolerate SSRI therapy. Some examples of the side effects associated with the use of tricyclic antidepressants include stomach upset, constipation, blurred vision, fatigue and dizziness.
Reviewed by Sally Robertson, BSc