Treatment Overview
Treatment for OCD includes counseling and medicines. Depending on how bad your symptoms are, your doctor may prescribe only counseling, or you may have both counseling and medicine. Using both tends to works best.
The sooner you get treatment, the better. Early treatment can reduce symptoms and make the illness less disruptive in your life.
Counseling
Exposure and response prevention (ERP) therapy works well to treat OCD. With ERP, you are exposed to an obsession, such as something you fear is dirty, over and over again. Each time, you try not to do the compulsive action that goes with it. In this case, the act would be washing your hands. ERP helps break the link between your obsessive thoughts and compulsive actions. You repeat this process every day for several weeks or months. You keep doing it until you are less anxious and you don't feel the need to do the compulsive action in response to the obsessive thought.
When you start ERP, your therapist may ask you to write a list of your obsessions, your actions (compulsions), and the things that you avoid. Then you'll rank them by how much anxiety they cause. You might start working on one that causes moderate anxiety. Then you would work your way up the list to the one that causes the most anxiety.
Therapists often combine ERP with cognitive-behavioral therapy (CBT) to help stop the false beliefs that lead to OCD behaviors.
Medicines
After you are diagnosed with OCD, your doctor will likely prescribe antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These medicines are thought to help balance neurotransmitters (such as serotonin) in your brain.
Examples of SSRIs are:
- Fluoxetine (Prozac).
- Fluvoxamine (Luvox).
- Sertraline (Zoloft).
Antidepressants help relieve obsessive thoughts and compulsive behaviors. They increase the level of serotonin in the brain. This helps regulate the communication between different parts of the brain.
In some cases, it takes time to adjust the dosage or find the right medicine that will work for you. You may start to feel better within 1 to 3 weeks after you start to take an SSRI. But it can take as many as 12 weeks to see more improvement. If you don't notice any improvement by 3 weeks, talk to your doctor. He or she may increase the dosage, switch to another SSRI, or use another medicine—clomipramine—if the medicine first prescribed doesn't help. Clomipramine has been used for years to treat OCD. But it may have more side effects than SSRIs.
Your doctor may prescribe other medicines if you have other conditions along with OCD.
Ongoing treatment
Ongoing treatment for OCD includes watching the dosage of your medicines and how well they are working. Your doctor may want you to stay on one medicine for at least 10 to 12 weeks before you try a different one. Antidepressants are thought to be the medicine that works best for OCD. But researchers are studying whether other medicines can be combined with antidepressants for better results.
If you are in counseling, your doctor will watch your progress. If needed, he or she may change the amount or type of counseling you get. You may need 13 to 20 sessions to relieve symptoms. Your doctor may also advise family members to take part in therapy with you or on their own.
Treatment if OCD gets worse
In rare cases of OCD when other treatment hasn't helped, deep brain stimulation may be tried. This involves magnetic stimulation of parts of the brain through surgically implanted electrodes.
What to think about
Consistency is important for both counseling and medicines. People who don't take their medicines on schedule or who stop taking them often have their symptoms return (relapse). With therapy, it's important to work with your doctor to find out when, or if, you should stop.
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