Obsessive-Compulsive Disorder (OCD) is an anxiety disorder in which a person experiences repetitive irrational thoughts (obsessions) and feels the need to act on them with repetitive activities (compulsions). It generally starts early in life and is a chronic, long-term condition. Therapy usually does not completely eliminate the condition but can be expected to improve the symptoms. Relapses are common and long-term therapy may be required in many patients. Standardized rating scales are used to assess the severity of OCD initially and are repeated after various treatment modalities to determine response to therapy. If a person remains free of symptoms for one to two years, it may be possible to gradually discontinue medication with the understanding that it may have to be resumed if symptoms recur.
Counseling
Counseling by a trained professional should be offered to all patients with OCD. The counseling, known as cognitive-behavioral therapy, is aimed at lessening a person's anxiety over a situation by gradually increasing exposure to the situation and delaying the need to act on it. For example, if a person is obsessed with cleanliness and feels compelled toward excessive hand washing after touching any potentially "dirty" object, the cognitive-behavioral therapy would encourage the individual to hold a "dirty" object and wait before washing, both for increasingly longer time periods. The Expert Consensus Panel for Obsessive-Compulsive Disorders recommends 13 to 20 weekly sessions of therapy which may be done individually or in a group setting. Counseling may actually be more effective than drug therapy, with about 66 to 75 percent of patients responding.
Antidepressant Medications
Therapy with one of several antidepressant medications FDA-approved for OCD should be used in combination with counseling for patients with OCD of at least moderate severity. If counseling is not available, the medications can be used alone. The medicines usually tried first for OCD are fluoxetine (Prozac®), fluvoxamine, paroxetine (Paxil®), or sertraline (Zoloft®). The dose should be tapered up slowly to reduce side effects and likewise should be tapered off slowly to prevent withdrawal symptoms if it is decided to discontinue the medication. At least one to three months of therapy are necessary to determine if the medicine is working. If the first medicine is not working, at least one of the other drugs should be tried. Unfortunately, there is currently no way to predict which medication is likely to be effective for a given patient. Another antidepressant, clomipramine (Anafranil®) is also FDA-approved for OCD and is sometimes used. Side effects that may occur with these medicines include sedation, nausea and sexual dysfunction.
Other Medications
If a person has not responded to counseling plus an adequate trial of at least two of the antidepressant medications listed above, other drugs may be tried. These include citalopram (Celexa®), venlafaxine (Effexor®), risperidone (Risperdal®), olanzapine (Zyprexa®), and quetiapine (Seroquel®). All of these affect levels of chemicals in the brain used by nerves. These drugs are usually reserved for patients not responding to first-line agents because they either have not been studied as well or are associated with more severe side effects.
References
- "America's Pharmacist"; Obsessive-Compulsive Disorder: An Overview for Pharmacists; Jennifer P. Askew, Pharm.D., Emily L. Heil. December 2007
- "Pharmacotherapy: A Pathophysiologic Approach"; DiPiro JT, Talbert RL, Yee, GC, et al, editors, 2005. Chapter 70 "Anxiety Disorders II: Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder", Cynthia K. Kirkwood, Eugene H. Makela, Barbara G. Wells.
- "AHFS Drug Information"; McEvoy GK, editor; 2009.
