How is OCD treated?

Obsessive-compulsive disorder does not simply disappear on its own, therefore, it is vital to seek professional help and treatment. Doctors tend to opt for the most effective method of treatment which combines the use of cognitive behavioural therapy (a form of psychotherapy) and medication.

There is no known cure for OCD, and treatment seeks to control the symptoms so as to prevent them from interfering with the patient’s daily life and activities. Some patients require lifelong treatment.

Psychotherapy

CBT (cognitive behavioural therapy), which as previously stated is a form of psychotherapy, has been seen to have effective results in a number of OCD cases. A type of this treatment is known as ERP (exposure and response prevention). This involves gradually exposing the patient to an object or obsession they fear, such as germs and dirt. After which, the patient is then taught certain coping techniques to manage their guilt or anxiety associated with the obsession. This form of treatment requires practice and effort, but can often result in the patient living a more productive and normal life as they learn to recognise and deal with their obsessions and compulsions.

Psychotherapy may take place with a psychiatrist and the patient only, or family and friends may also be invited for group sessions in order to help the patient when he or she faces obsessions in the future.

Medications

There are a number of specific psychiatric medications that can be prescribed to help control the patient’s obsessive and compulsive behaviour. The most common form of medication first prescribed is antidepressants.

The following antidepressants have been approved to treat OCD:

• For children who are 10 years old or older as well as adults - Clomipramine (Anafranil)
• For children who are seven years or older as well as adults - Fluoxetine (Prozac)
• For children who are eight years or older as well as adults – Fluvoxamine
• For adults only - Paroxetine (Paxil and Pexeva)
• For children who are six years old or older as well as adults - Sertraline (Zoloft)

Antidepressants may be prescribed with other psychiatric medications too.

Medications: What to take into consideration

There are a number of issues for the patient to discuss with their doctor for the treatment of obsessive-compulsive disorder, these are:

• Choosing the right medication – The end-goal is to control the symptoms of OCD with the lowest dose possible in order to get the most effective results. It is often the case that the doctor and patient will work together and try a number of medications before they are able to find the most effective one. The doctor may recommend that the patient takes a combination of more than one medication. It can sometimes take weeks or months in order to see the results and judge the effectiveness of the medication.
• Side effects – All forms of psychiatric medication have side effects. It is advised that the patient speaks to their doctor about the potential health risks due to these side effects and that the patient fully discloses any side effects to their doctor.
• The risk of suicide – In general, antidepressants are safe to use as a form of medication. In rare cases, children and adolescents experience suicidal thoughts or behaviour when they take antidepressants, particularly in the first couple of weeks of treatment, or if the dosage is changed. If thoughts of suicide appear, the patient is advised to seek immediate medical attention and that their treatment is changed. However, it is important to also bear in mind that the long-term treatment effect of antidepressants results in the improvement of the patient’s mood.
• The interaction of other substances – If the patient is currently taking antidepressants, it is advised that they tell their doctor about any other over-the-counter or prescription medication, supplements or herbs they may also be taking. This is due to the fact that some antidepressants have been known to result in dangerous reactions if they are combined with other supplements or medications.
• Stopping antidepressants – Although taking antidepressants does not lead to an addiction to the medication, sometimes a physical dependence can develop. Should the patient abruptly stop treatment or miss a number of doses, they may start to experience symptoms similar to those of withdrawal. This is sometimes referred to as discontinuation withdrawal. By stopping the medication, the patient’s symptoms can resurface. Should the patient wish to discontinue their medication due to side effects or personal reasons, it is best that they speak to their doctor about lowering the dosage in phases so as to gradually stop the treatment.

Other forms of treatment

In some cases, psychotherapy and medications are not an effective solution to control the symptoms of OCD. There is ongoing research being done to evaluate the effectiveness of DBS (deep brain stimulation) for the treatment of patients with obsessive-compulsive disorder who do not respond to the approach of traditional treatment. At this stage, the treatment is still regarded as experimental.

DBS is a procedure that uses the implantation of a device that measures brain activity. A thin wire with several electrodes at the tips of it is implanted into the specific parts of the brain responsible for causing the obsessive behaviour associated with OCD, this device then stimulates these areas of the brain in order to measure how to brain reacts. These electrical impulses may also aid in blocking certain areas of the brain, preventing dysfunction and normalising brain activity.

In more severe cases of OCD, ECT (electroconvulsive therapy) has been used to treat the condition. During ECT, a small current is applied to the patient’s brain via electrodes which are placed on the scalp while he or she is put into a state of sleep under a general anaesthetic. This small current causes a seizure in the patient’s brain. This form of treatment is said to improve the symptoms of OCD through ‘re-wiring’ the framework of the brain through the brief seizure.