OCD: Getting Control of Your Obsessions and Compulsions - Treating Obsessive Compulsive Disorder

Written by HealthyPlace.com Staff Writer

David: I want to touch on the area of medications. What are the most effective medications for OCD?

Dr. Baer: The antidepressant medications that are called SRI drugs. These all increase the serotonin available in the brain. They are Anafranil (Clomipramine), Prozac (Fluoxetine), Luvox (Fluvoxamine), Paxil (Paroxetine), Celexa (Citalopram Hydrobromide). There are other drugs that work too, but these are the first line treatments. I forgot to mention Zoloft.

poe: Hello, I'm Poe. I've just been diagnosed with OCD and depression. I was put on Clomipramine but it made me too sick. I have to wait until the 10th to get a different medication. The waiting is the worst part. What can I do in the meantime to keep from going more frustrated and incapacitated?

Dr. Baer: For the depression cognitive therapy can be very helpful. Dr. Burns's book Feeling Good is a classic. Of course, I'd also suggest you try some self-help for the Obsessive-Compulsive Disorder. This is especially important because all of these drugs can take up to 12 weeks to have any effect on OCD symptoms.

David: I think Shelly mentioned this earlier, but here's a similar comment from Poe:

poe: Lately, I've thought of self injury as a way to cope with the ocd and depression. How do I go about repressing these urges?

chilly: I take Paxil, which relieved the depression and Aderall and Paxil should relieve anxiety, yet my "need to control" through senseless OCD habits still persists. What can help?

Dr. Baer: It is important to distinguish suicidal thoughts and self-injury for this reason, from urges that seem to build up to do something to relieve the tension. Suicidal thoughts are caused by depression and hopelessness, while the urges to do impulsive acts to relieve tension are part of the OCD spectrum disorders.

David: Earlier, Dr. Baer mentioned that people with OCD sometimes start out by being highly critical of themselves. Here's a comment from Chilly along those same lines:

chilly: My self-injury began in trying to improve my looks, which I have obsessive thoughts about. This habit has done the exact opposite! It makes my looks worse, is defeating the purpose.

Dr. Baer: Another of the disorders that is part of the OCD spectrum is "body dysmorphic disorder" where the person thinks that some part of his or her appearance is ugly or somehow not right. We often see people who pick at their skin or other things to try to improve their appearance. For this disorder, I recommend Dr. Phillips book "The Broken Mirror".

Steve1: How much association does Obsessive-Compulsive Disorder have with Panic Disorder and if you have Panic Disorder what are the chances of you developing OCD?

Dr. Baer: There is some overlap between OCD and panic disorder, but much less than we would have expected. The vast majority of people with panic disorder will never develop OCD. I mentioned at the beginning that in a few cases of OCD, traumatic experiences may have triggered the symptoms, and we often see both panic and OCD symptoms co-existing in these cases.

dofraz: Please provide some therapy techniques for non-medicated children diagnosed with OCD. I need help with a 4 year old girl. We are looking for information. We have met with several doctors who have diagnosed her with OCD. My daughter will not count past 9 or say most people's names. We were working with a behaviorist with very little success.

Dr. Baer: At the risk of sounding like a bookstore, I would strongly recommend that you get Dr. John March's book(s) on behavioral treatment of children with OCD. He explains how, at Duke University, he modifies behavior therapy in terms kids can understand and gets excellent results, usually with no, or very little medication. The techniques are the same in treating kids as adults, but of course it has to be explained differently.

David: Here's an audience comment on how medications helped her:

MalibuBarbie1959: Luvox has helped my symptoms but Anafranil completely took it away.

Dr. Baer: These are the only two SRI drugs that are sometimes prescribed together. They often seem to complement each other when a single drug doesn't work.

astrid: Is an obsessive thought about suicide something that I should be concerned about or should I try to dismiss the thought along with my other obsessive thoughts?

Dr. Baer: If the thought is about wishing to be dead, or is part of feeling very depressed and hopeless, then it is NOT considered an obsessive thought and shouldn't be treated as one. Then it should be treated as a serious symptom of depression. But some people say that they don't wish to be dead, and are not depressed, but sometimes get images of harming themselves that get stuck in their heads. These could be obsessive thoughts. Of course, it is important to take any suicidal thoughts seriously and see a professional, and it will probably take a professional to tell these thoughts apart. I would therefore suggest talking to a professional before trying self-treatment for this symptom.

ict4evr2: I have suffered with Obsessive Compulsive Disorder for as long as I can remember. It has been a very secretive, private illness. However, others have obviously seen bizarre behavior. I have made a feeble attempt at drug therapy once. My question is do people with OCD develop other major problems later in life if OCD is not treated early?

Dr. Baer: Other disorders do not develop, and the OCD usually remains at about the same level if not treated; although, of course, more relationships and job situations are affected as people have OCD longer. But many people come to us in their 50's and 60's seeking treatment for the first time, and respond very quickly.