Obsessive-compulsive disorder (OCD) is generally considered a lifelong condition as there isn’t a one-and-done “cure.” However, that doesn’t mean your life’s on hold. With the right treatment or combination of treatments, many people learn to manage their symptoms and enjoy a fulfilling and meaningful life. From therapy to medication, here’s a breakdown of some of the best treatment options for OCD.
Therapy is often recommended as a first-line treatment for OCD, especially in mild cases. Some people find that working with a therapist on its own is enough, while others benefit from combining therapy with another treatment like medication.
When participating in a therapy session, you can expect to gain control over your condition by learning how to understand and manage your thoughts and behaviors. Here’s a closer look at three common types of therapy used in treating OCD.
Cognitive behavioral therapy (CBT) is one of the most effective treatments for OCD. It’s offered in both one-on-one sessions and group settings, so you have flexible options depending on your comfort and needs.
CBT works by helping you recognize and challenge the unhelpful thoughts that lead to compulsive behaviors. For example, if you find yourself repeatedly checking a door to feel safe, a therapist might encourage you to ask yourself, “Does checking the door over and over really make me any safer, or does it just feed my anxiety?” Through exercises like keeping a thought journal or practicing gradual exposure to anxiety-provoking situations, you learn to break the cycle of obsession and compulsion.
Exposure and response prevention (ERP) is a subtype of CBT that focuses on the behavioral aspect of OCD. Instead of avoiding the things that trigger your anxiety, ERP encourages you to face them head-on. Studies have found that ERP can improve OCD symptoms, reducing both anxiety and depressive feelings by almost 45-48% on average.
There are two ways ERP is carried out. In vivo exposure involves confronting real-life situations that trigger your OCD. For example, if you worry about contamination, you might start by touching something you consider “dirty” and then practice not washing your hands immediately afterward. Over time, this repeated exposure helps reduce the anxiety tied to that trigger.
On the other hand, there’s imaginal exposure, where you imagine a scenario that ignites your fear. This method is useful when direct exposure isn’t safe or practical, such as when your fears involve more distressing scenarios, like aggression. By creating a detailed mental picture of the feared situation and imagining the outcomes without performing your usual rituals, you gradually build up a tolerance for the anxiety.
Acceptance and commitment therapy (ACT) is different from other therapies for OCD that focus on directly reducing or getting rid of obsession and compulsions. Rather than trying to change or challenge your thoughts, ACT helps you learn how to relate to them in a new way. It’s meant to reduce OCD’s impact on your life so that you can focus on what truly matters.
With ACT, you work on accepting unwanted thoughts and feelings without letting them dictate your actions. This means recognizing that these mental events are simply a part of your experience, not enemies that need to be fought.
ACT is build around six components:
One study found that just eight sessions of ACT reduced both the frequency of obsessions and compulsions, as well as the distress they caused. Instead of getting caught up in dissecting every thought, patients learned to see them as passing mental events, which allowed them to focus on living a life not ruled by their OCD.
While therapy can help you learn to work with your obsessions and compulsions, medications can balance the chemicals in your brain that are affected by OCD. While medications might not completely erase symptoms, many people still experience substantial relief when they’re combined with other treatments like therapy.
Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly prescribed medications for OCD. SSRIs work by preventing your brain from reabsorbing serotonin, which is a chemical messenger that helps regulate mood and anxiety. With more serotonin available between nerve cells, these medications can improve communication in the brain, which in turn can result in reduced intrusive thoughts and repetitive behaviors.
SSRIs that are prescribed for OCD include:
While SSRIs are generally preferred for their more favorable side effect profile, they can still cause some discomfort. Common side effects might include nausea, feelings of nervousness, trouble sleeping, or reduced sexual desire. These effects often lessen over time, and your healthcare provider can help adjust your medication to better suit your needs.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) aren’t usually the first option for OCD, but they may be prescribed when SSRIs don’t provide enough relief. These medications block the reuptake of serotonin and norepinephrine, which are neurotransmitters in charge of regulating mood and anxiety. This dual action can sometimes help fine-tune the chemical balance in your brain, especially if you’re also experiencing symptoms of depression or heightened anxiety.
Two SNRIs that may be prescribed are venlafaxine (Effexor) and duloxetine (Cymbalta). Although the evidence for their effectiveness in OCD isn’t as strong as it is for SSRIs, some patients do experience significant benefits when switching or adding an SNRI to their treatment plan.
Clomipramine is the only tricyclic antidepressant (TCA) approved by the FDA for the treatment of OCD. It works by blocking the reabsorption of serotonin and norepinephrine, similar to SNRIs; however, it can cause more adverse side effects like drowsiness, dry mouth, and weight gain.
Some research suggests clomipramine might be better in reducing OCD symptoms, while other studies indicate that its effectiveness is similar to that of SSRIs. Additionally, there’s evidence that adding clomipramine to an SSRI regimen can be beneficial for those with treatment-resistant OCD.
When SSRIs alone don’t do the trick for OCD, doctors might add an atypical antipsychotic to your treatment. This is called augmentation and is meant to give your current medication regimen a boost. Research shows that augmenting an antipsychotic with another medication is more effective than a placebo, with about one in three patients seeing OCD symptom improvement.
Effective atypical antipsychotics for OCD include:
These medications have shown positive results when added to an SSRI regimen for treatment-resistant OCD. However, if you don’t see any improvement within the first month of adding an antipsychotic, continuing the treatment may not be beneficial.
Before being prescribed an antipsychotic, it’s recommended that SSRIs are given a full trial for at least a few months to see if they work on their own. As with any medication, there can be potential side effects, so your healthcare provider will help you monitor your progress and adjust your treatment plan as needed.
Even with the best efforts using medications and behavior therapy, about 10% of patients still face chronic and severe OCD symptoms. Fortunately, there are alternative treatments that may be considered, including ketamine therapy, deep brain stimulation, and transcranial magnetic stimulation.
Ketamine is a fast-acting IV-infusion treatment that has been shown to rapidly improve depressive and OCD symptoms by targeting glutamate receptors in the brain. In one study, OCD scores dropped by almost 50% within the first hour after treatment. Patients with co-occurring depression also reported improvements in mood.
However, these benefits for OCD tend to be short-lived. While the immediate drop in symptoms is promising, the anti-obsessive effects start going away within a few hours and generally return to baseline within a week. Repeated treatments might be necessary to maintain any benefits.
As it stands, ketamine therapy for OCD is still considered experimental. More research is needed to determine its long-term efficacy and to establish optimal treatment protocols.
Deep brain stimulation (DBS) is a surgical option for severe OCD that hasn’t responded to other treatments. While typically not recommended as a first-line treatment, up to 70% of patients who’ve undergone DBS have seen a long-term improvement in their symptoms.
In this procedure, surgeons implant thin electrodes into deep areas of the brain that are affected by OCD. These electrodes are connected by wires to a small pulse generator placed in the chest (similar to a pacemaker) that sends electrical currents to help regulate brain activity.
For people with OCD, the brain regions involved in procession information and making decisions are often intertwined. This connection can make it hard to think clearly and rely on thoughtful actions, resulting in more habitual or reflexive behaviors. DBS normalizes the communication between these brain areas, thus reducing symptoms.
Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to target areas of the brain involved in OCD symptoms. A typical session lasts about 20-30 minutes, allowing you to quickly return to your daily routine. Most treatment plans require daily sessions over a period of several weeks.
Research supports its effectiveness. For instance, one study showed that 45.2% of patients in the active TMS group saw improvement, compared to 17.8% in the placebo group. Additionally, side effects are usually mild and temporary, but some patients might experience:
Living with OCD doesn’t have to mean you need to live a life that’s defined by your symptoms. OCD might be a lifelong condition, but there are treatments available, like therapy, medication management, and TMS.
If you’re ready to take the next step toward managing OCD and reclaiming your life, Cura Behavioral Health is here to help. Contact us today to learn more about our services.
Determining if TMS therapy suits your mental health journey should involve consultation with a qualified professional. At Cura Behavioral Health, we provide comprehensive assessments to help you make informed treatment decisions.
Don’t let a mental health condition hold you back any longer. Schedule a consultation with Cura Behavioral Health today. Our experienced team is ready to answer your questions and create a personalized treatment plan tailored to your unique needs.
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Dr. Kevin Simonson, an esteemed Medical Director at Cura Behavioral Health, brings over 15 years of experience in psychiatry. A graduate from a top medical school, he specializes in the treatment of mood disorders and anxiety, employing a patient-centered approach. His dedication to evidence-based care and his commitment to advancing mental health practices have made him a respected figure in the field. Dr. Simonson’s leadership ensures the highest standard of care for the community at Cura Behavioral Health.
