Obsessive-compulsive disorder (OCD) is a mental condition characterized by anxiety-causing thoughts and beliefs, together with behavior and rituals intended to lower the level of anxiety down to normal that end up adding to it. Though the FDA has approved different classes of antidepressants as OCD medication, they may cause side effects and are not always effective. This has caused many patients and healthcare professionals to rely on alternatives in treating this condition. It is strongly recommended you consult with your doctor before deciding which treatment course is right for you.
Psychopharmacology, or medication, is considered one of the more effective treatments for OCD, though it does involve certain elements that prevent it from being an option for all patients.
The most commonly prescribed medications for OCD are antidepressants, which are mainly used to treat depression. Out of the different classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) are usually prescribed to treat OCD.
SSRIs limit the reabsorption of serotonin, a type of chemical produced by neurons to communicate and cause cell excitation. After being released into the space between two neurons and facilitating cell communication, serotonin is naturally absorbed back into the original neuron it came from. By interfering with this process, SSRIs help keep the serotonin active for a longer period of time.
Serotonin has been found to be involved with nearly every type of behavior or experience, from physical reactions to inducing emotions and cognitive responses. In addition to OCD, an imbalance of serotonin has been linked to mood disorders, most notably to depression.
Though it remains unclear how antidepressants, and specifically SSRIs, help assuage symptoms of OCD, their efficacy in alleviating symptom severity has repeatedly been proven. That said, adults with OCD are usually prescribed higher doses of SSRIs than adults with depression, which can cause more adverse side effects and an unwillingness to continue with the treatment.
Even beyond the normally higher dosage for OCD, antidepressants can cause a number of side effects that can at times make it intolerable for patients battling OCD. Such side effects include dry mouth, nausea, suicidal ideation (in which case you are strongly urged to inform your doctor or seek emergency care), and trouble sleeping.
There are currently several available options beyond medication that have been proven to effectively treat OCD. These include Deep TMS, cognitive behavioral treatment (CBT), psychodynamic therapy, and surgical procedures.
Deep TMS: Deep Transcranial Magnetic Stimulation (dTMS) is a proven effective treatment that utilizes magnetic fields to safely regulate the neural activity of brain structures found to be linked to various mental health conditions.
Deep TMS has been shown to offer substantial symptom relief for OCD in a 2019 multicenter, sham-controlled study published in American Journal of Psychiatry. FDA-cleared for treating OCD since 2018, the treatment has been successfully offering symptom relief for a growing number of patients.
In addition to being found effective for OCD symptom relief in repeated studies, Deep TMS has also been shown to be a safe and well-tolerated treatment. A 2007 study published in Clinical Neurophysiology confirmed this, finding Deep TMS’s technology and treatment process to be both safe and feasible.
Finally, due to its non-invasive process, dTMS does not involve anesthesia and can be integrated into a patient’s daily schedules.
Cognitive Behavioral Therapy: CBT is a type of talk therapy considered to be a first-line treatment option for OCD. CBT maps out the different aspects that comprise the patient’s overall experience by looking at the feelings, thoughts and beliefs, behavior and physical responses associated with the condition they are battling. By doing so, CBT aims to take the anxiety-inducing symptoms that characterize OCD from an unclear, threatening, adverse experience, into one that is better understood and responsive to changes carried out by the person experiencing it. By doing so, CBT is able to contribute to alleviating OCD symptoms.
As CBT developed, different approaches grew out of the original theory, with some found to offer patients with OCD a more efficient treatment course. Among them is Acceptance and Commitment Therapy (ACT), which expands on openness and flexibility in addressing OCD symptoms. During ACT, patient and therapist delve into the features that define how the patients experience their OCD, as they begin to develop a greater sense of commitment to improving their own well-being.
Exposure and Response Prevention therapy (ERP) is another form of treatment shown to effectively alleviate OCD symptoms. ERP exposes the patient to stimuli the patient associates with their condition, while gradually choosing stimuli that increases their level of anxiety. The patient is offered emotional support by the therapist, as they work to avoid reacting to said stimuli according to the compulsory behavior derived from their condition. Over time, they are able to prevent themselves from responding in an OCD-related manner, and are more successful in avoiding the anxiety-inducing thoughts and behaviors that negatively affect them.
Psychodynamic Therapy: An additional type of talk therapy that has been found to offer relief from OCD symptoms is psychodynamics. This form of treatment considers different aspects of the patient’s life, such as their relationships, personality features, life story and events, perspective on the world and on themselves, in an effort to see what elements may be linked to the development of their OCD. As the treatment progresses, the patient can begin to reflect on their condition, consider new alternatives to the automatic responses their anxiety would normally induce, and rely instead on more reactions more beneficial to their well-being.
Not all patients facing OCD find relief through first-line treatment such as CBT or medication. Such treatment-resistant patients may ultimately be offered neurosurgery in an effort to mitigate the condition’s adverse effect on their lives.
A number of neurological lesion methods have been found helpful for treatment-resistant patients. These include standard craniotomy, gamma knife coagulative lesions, and implanting radioactive seeds. Ablative, neurosurgical options hone in on the brain’s cortico-striato-thalamo-cortical circuit, known to be hyperactive among those experiencing OCD symptoms.
Such invasive treatments, however, require a recovery period following surgery. Additionally, with many of the studies examining these treatments based on a relatively small number of patients, more tests are needed to establish their efficacy among patients with OCD.
These days, there is more awareness and treatment options available to those facing OCD than ever before. In many cases, the different possible courses of therapy can be combined as a multi-tiered approach, which can offer even greater relief. That said, finding the right treatment or combination thereof is a journey, and as with other forms of exploration, it is recommended that you rely on an experienced guide to see you through. It is therefore important to confer with a mental health professional familiar with your medical history, as you learn more about the condition you are facing and the ways you can manage it to improve your quality of life.