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Treatments for Obsessive-Compulsive Disorder (OCD)

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

There are various types of treatments that have been found to be effective for OCD. See here for recommendations on when to consider using each of these different modalities.

Psychotherapy for OCD

The main form of psychotherapy to have been rigorously studied for treating OCD has been Cognitive Behavioral Therapy (CBT), and it has been shown to be quite effective [ref, ref].

Exposure and Response Prevention (ERP), a form of Behavioral Therapy, is also very commonly employed to treat this condition [ref], and seems to be roughly equivalent to CBT in its efficacy [ref]. In practice, elements of CBT and ERP are often combined when treating OCD.

Medications for OCD

Medications are also very commonly used to treat OCD, the main ones being those with strong serotonergic properties like the SSRIs and Clomipramine [ref, ref]. Although Clomipramine may be slightly more effective than the SSRIs [ref], the SSRIs are still preferred as the first-line treatments because they tend to cause fewer side-effects. Often, they need to be used at high doses beyond what is normally given to treat Depression or other Anxiety Disorders [ref]. Venlafaxine also shows promise as an effective treatment [ref].

When any of these medications are not effective enough on their own, the standard practice is to add an Atypical Antipsychotic or Haloperidol, which seem to be particularly effective when the individual also suffers from Tics [ref, ref].

There are also various other medications that can be tried, though they have been less rigorously studied and their efficacy is less well established. These include: Mirtazapine [ref], D-Cycloserine [ref], Pindolol [ref], Morphine Sulphate taken once a week [ref], and Topiramate [ref].

Combination of Psychotherapy and Medications for OCD

Studies done on children and adolescents with OCD have revealed that a combination of psychotherapy (CBT and/or ERP) and medications is superior to either treatment alone [ref, ref].

In adults, such findings have been less definitive; it may be that combining psychotherapy and medications is preferable when the individual has a severe form of OCD or suffers from a co-occuring condition like Depression [ref], but that otherwise it may be best to start first with psychotherapy and then later add medications if necessary [ref, ref].

Other Treatment Options for OCD

Kundalini Yoga may be helpful for treating OCD according to one study [ref].

For treatment-refractory cases of OCD, and especially when there is co-occuring Depression, ECT may be an effective option [ref].

Other options for severe and treatment-refractory cases include Deep Brain Stimulation [ref, ref, ref] and Psychosurgery [ref]. Because of the invasive nature of these procedures, and because they are not successful in all cases, they are reserved for carefully selected patients who have failed to respond to trails of most other available treatments.

 

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Course & Prevalence

Treatment Guidelines