How Obsessive-Compulsive Disorder Is Treated

People with obsessive-compulsive disorder (OCD) often experience significant improvement in symptoms with proper and timely treatment. Depending on the severity of your symptoms and other factors, your treatment plan may include prescription medications, psychotherapy, or a combination of the two.

Read on to learn more about the various methods used to treat OCD.

Obsessions and compulsions are time-consuming and can create significant distress. In some cases, OCD can interfere with the ability to function in daily life. It is unknown what causes it, but it is thought that multiple factors, including genetics, biology, and stress, play a role.

Prescription Medications

A type of antidepressant medication known as selective serotonin reuptake inhibitors (SSRIs) is the most common medication used to relieve OCD symptoms. SSRIs are traditionally used to treat depression. Research has shown that they are the most effective medications for OCD, as well.

These medications work by influencing certain neurotransmitters in the brain, specifically serotonin and dopamine. Neurotransmitters are chemical messengers that carry signals between nerve cells in the brain.

SSRIs that have been found to work well for OCD in research studies include:

• Paxil (paroxetine)
• Luvox (fluvoxamine)
• Prozac (fluoxetine)
• Zoloft (sertraline)
• Celexa (citalopram)
• Lexapro (escitalopram)

Most of these medications effectively treat the symptoms of OCD over both the short- and long-term. 

SSRIs are often given at higher daily doses in the treatment of OCD than in treating depression. They may take some time to start working (between eight and 12 weeks), though some experience improvement sooner.

A 2019 paper reviewed studies of prescription medications used to treat OCD and found that while prolonged administration of SSRIs is the most effective, there are better results if SSRIs are used in combination with therapies such as cognitive behavioral therapy (CBT).

Anafranil (clomipramine), a tricyclic antidepressant, was the first drug used to treat OCD. It is as effective as SSRIs, or slightly more so. However, it has more severe side effects and is normally prescribed only if SSRIs do not work.

Side effects of Anafranil include drowsiness, dry mouth, decreased concentration, and nausea. It can also lead to weight gain.

Recent research has shown that a different type of antidepressant, serotonin-norepinephrine reuptake inhibitors (SNRIs), might also effectively treat OCD symptoms. These include Effexor (venlafaxine) and Cymbalta (duloxetine).

Antipsychotic Augmentation

About 40% to 60% of OCD patients are thought to fail to respond if they receive treatment solely through SSRIs. “Response” in this case is defined as a 25% to 35% reduction in the Yale-Brown Obsessive-Compulsive Scale, which is a test that rates the severity of OCD symptoms. 

If symptoms do not improve with a switch to other antidepressants, then there is evidence that prescribing antipsychotic medication, in addition to antidepressants, may be effective in some cases. 

Antipsychotics that have been shown to be effective include:

• Risperdal (risperidone)
• Abilify (aripiprazole)

A 2013 review of double-blind, randomized, placebo-controlled trials found that a significant number of those who did not respond to serotonin reuptake inhibitors (SRIs) treatment did improve with the addition of an antipsychotic.

Therapy

The main type of therapy used to treat OCD symptoms is cognitive behavioral therapy (CBT). This is a psychotherapy approach that works by helping patients identify and change maladaptive thoughts and behaviors.

It is also commonly used to treat mental disorders such as depression and anxiety disorders, which are highly prevalent among those with OCD. 

Exposure and Response Prevention (ERP)

The type of CBT most commonly used to treat OCD is exposure and response prevention therapy. ERP involves putting you in a situation that triggers your obsessions (exposure) and then prevents you from undertaking the usual resulting compulsion (response prevention). 

For example, someone who may be triggered to have obsessional thoughts when in a situation where there are dirty objects would be exposed to that situation and then prevented from washing their hands. 

Therapy sessions may involve you being exposed to real or imaginary situations. Exposure can also involve exposure to the physical sensations associated with anxiety or discomfort.

CBT, including ERP, has been established as an effective treatment of OCD. A 2019 meta-analysis of randomized placebo-controlled trials found that CBT was associated with significant improvement when treating OCD. 

A systematic review and meta-analysis of studies published between 1993 and 2014 found that CBT resulted in substantial symptom improvement among those with OCD. It was also concluded that CBT was significantly better than antidepressants.

However, there are some drawbacks to therapies such as ERP. One is that it requires the patient to be put into a very stressful situation where they are purposefully prompted to feel anxiety.

This can be distressing for both the therapist and the patient. According to some studies, about 25% to 30% of patients drop out of ERP treatment prematurely. 

Alternative Treatments

Several neurobiological systems are connected to OCD, including specific brain circuits, which are neural pathways that carry out a specific function.

There are alternative treatments that target these systems for those whose OCD does not respond to traditional treatments of prescription medications and therapies.

Repetitive Transcranial Magnetic Stimulation (rTMS)

This is a noninvasive treatment that uses magnetic fields to activate the brain. Unlike some other brain stimulation therapies, it can be targeted to specific regions of the brain.  

The FDA approved rTMS for the treatment of OCD in 2018. It is also approved for the treatment of depression and certain migraine headaches. 

rTMS involves placing a small magnetic device containing a coil of wire against the head near the area of the brain that the treatment is targeting. Short electromagnetic pulses are administered through the coil, which stimulates nerve cells in that area. The magnetic field's strength is about the same as that of a magnetic resonance imaging (MRI) scan.

You may feel a slight knocking or tapping on the head as the pulses are administered. After treatment, you might also experience some discomfort at the side of the head where the magnet was placed.

It is thought to be a safe treatment without serious side effects. Two large-scale studies on the treatment's safety found that most side effects, such as headaches or scalp discomfort, were mild or moderate, and no seizures occurred.

However, as the treatment is relatively new, the long-term side effects are not currently known.

Deep Brain Stimulation (DBS)

Deep brain stimulation is an invasive procedure that involves surgery on the brain in which electrodes are implanted in the part of it believed to be associated with OCD.

You will be awake when the electrodes are first placed, though you won't feel anything because your head will be numbed with local anesthetic. After the electrodes are identified as having been placed in the right area, you will be put under general anesthesia so that battery-powered stimulus generators can be implanted in your chest.

Electric pulses are then continuously delivered to the electrodes. It is not clear exactly how DBS works, but it is thought that the pulses help to “reset” the region of the brain that is targeted.

Only a very small percentage of those with OCD will be eligible for this treatment. It is considered only if symptoms are extremely severe and there has been no response to other forms of treatment.

A 2015 meta-analysis of studies on DBS between 1999 and 2014 looked at data from 116 subjects and found that DBS reduced OCD symptoms significantly. It concluded that DBS does constitute a valid alternative to other forms of invasive surgery to treat those with severe OCD.

The study noted that most of the published studies focused on symptom reduction and highlighted that, adding that more research was needed into changes regarding quality of life following this treatment.

Transcranial Direct Current Stimulation (tDCS)

In transcranial direct current stimulation, a weak but constant current is applied directly to the scalp. This is a relatively new treatment that is still being investigated. However, there is increasing evidence that it might be effective in treating the symptoms of OCD in those who do not respond to traditional treatments. 

It has advantages over both rTMS and DBS in that it is a less expensive form of treatment and more accessible. It also has a low side-effect profile.

Lifestyle

Getting treatment for OCD will generally involve a qualified mental health practitioner. However, several self-care strategies can help with your symptoms. 

These strategies can support your treatment plan and help reduce anxiety and stress, which are common among those who have OCD. 

Examples of self-care strategies are:

• Eating a healthy diet
• Exercising regularly
• Getting enough sleep
• Effectively dealing with minor illnesses and conditions

Exercise 

There is strong evidence that aerobic exercise, also known as “cardio," can improve mood and reduce anxiety. There is also evidence that aerobic exercise impacts the specific symptoms of OCD. 

A 2019 study of 55 patients with treatment-resistant OCD found that aerobic exercise resulted in significantly larger increases in positive mood and reduced anxiety and compulsions compared with weekly health education sessions. Examples of aerobic exercise are brisk walking, swimming, running, and cycling.

Stress

Stress is thought to be a trigger of the symptoms of OCD. Patients with OCD often report significantly more stressful life events in the months leading up to when their symptoms got worse. Stress is also thought to be connected to the development of OCD in some people, though exactly how is unknown.

Stress can also impact you while you are getting treatment for OCD. This is because stress or being in stressful situations might cause you to use poor coping strategies. It is important to understand how you are affected by stress and develop good techniques to cope with it.

Many types of therapy will focus on helping you develop good coping strategies. These strategies can help you deal better with stress and stressful situations.

A Word From Verywell

If you have been diagnosed with OCD, it can be challenging to cope with the symptoms, especially if they impact your daily life. Reaching out for support, either through support groups or talking to your healthcare provider or therapist, is important. Remember that managing your symptoms is possible, and there are effective treatments available.

It can also be challenging for those with a loved one who has been diagnosed with OCD. While most adults can identify their obsessions or compulsions, most children and some adults will struggle to see their behavior as out of the ordinary.

Remember that OCD is a biological illness and that those diagnosed with OCD cannot control the obsessions and compulsions they experience, even if they recognize them as excessive.