Despite rapidly gaining a reputation as the gold standard treatment for OCD, clomipramine showed to be outpatient mental health non-superior to SSRIs in a recent meta-analysis including 53 articles (42). Its side-effect profile (including epilepsy, increased liver enzymes, xerostomia, increased heart rate, constipation) calls for caution when prescribing it. Furthermore, the limit of accessibility to CBT should be considered, SSRI remaining the most cost-effective treatments (17). Indeed, financial cost, difficulty attending sessions and fear regarding anxiety-provoking exercises are the main perceived barriers to initiate and complete CBT (18). People with OCD might avoid situations that trigger their symptoms or use drugs or alcohol to cope.
Exposure and response prevention therapy (ERP) is a form of psychotherapy that’s well supported, and commonly used, for the treatment of OCD. It falls under the broader category of cognitive behavioral therapy, and you may notice several similarities to the treatment of anxiety disorders. A comprehensive treatment plan evolves as one gets to know the patient.
Will I have to take medications forever?
As noted earlier, comorbid depressive and anxiety disorders will commonly be present. These comorbid conditions may not respond to the particular serotonin reuptake inhibitor (SRI) prescribed for the patient’s OCD. Treatment approaches to such cases, including several kinds of psychotherapy, are also available. If a patient is abusing alcohol to reduce anxiety, this problem must be addressed. The presence of a tic disorder, schizotypal or borderline personality disorders, or a personal or family history of hypomania or mania should be explored, since these would influence therapy choices. At the end of the study, 89% of patients on memantine met the criteria for remission, defined as YBOCS score less than or equal to 16 compared with 32% in the placebo group (66).
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Other types of therapy that may be helpful include acceptance and commitment therapy, inference-based cognitive behavioral therapy, and mindfulness. ERP is now usually administered as part of a broader program of CBT specifically designed for OCD. After making the patient aware of his or her irrational thoughts, the therapist works to have the patient counter them with more rational thoughts and do cost/benefit analyses regarding performing his or her rituals. Patients who have achieved remission of symptoms with behavior therapy alone may never require medication and may instead need only to return to therapy if they have an exacerbation of their illness. Also, a subset of patients has been treated with a combined approach; these patients can discontinue medication, maintaining a remission with behavioral interventions alone.
Its effects have resulted in a growing number of patients asking—is OCD curable? OCD is a mental health condition involving recurring thoughts or images that you can’t control (obsessions), coupled with actions that you feel compelled to repeat over and over (compulsions). The cycle of obsessions and compulsions can take up large amounts of time and reduce your ability to carry out daily activities. Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears known as obsessions. These obsessions lead you to do repetitive behaviors, also called compulsions.