Obsessive-compulsive disorder

Alternative Names

Treatment

OCD is treated using medications and therapy.

The first medication usually considered is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). These drugs include:

• Citalopram (Celexa)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

If an SSRI does not work, the doctor may prescribe an older antidepressant called clomipramine. Clomipramine is the oldest medication for OCD. It works better than SSRI antidepressants in treating the condition, but it has unpleasant side effects, including:

• Difficulty starting urination
• Drop in blood pressure when rising from a seated position
• Dry mouth
• Sleepiness

In some cases, an SSRI and clomipramine may be combined. Other medications such as benzodiazepines may offer some relief from anxiety, but they are generally used only with the more reliable treatments.

Psychotherapy is used to:

• Provide effective ways of reducing stress
• Reduce anxiety
• Resolve inner conflicts

Behavioral therapies may include:

• Exposure/response prevention: You are exposed many times to a situation that triggers anxiety symptoms, and learn to resist the urge to perform the compulsion.
• Thought-stopping: You learn to stop unwanted thoughts and focus attention on relieving anxiety.

Outlook (Prognosis)

OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of improvement. However, a completely symptom-free period is unusual. Most people improve with treatment.

Possible Complications

Long-term complications of OCD have to do with the type of obsessions or compulsions. For example, constant handwashing can cause skin breakdown. However, OCD does not usually progress into another disease.

When to Contact a Medical Professional

Call for an appointment with your health care provider if your symptoms interfere with daily life, work, or relationships.

References

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:167-170.

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:1348-1350.

Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry, 2007;164:5-53.

Denys D. Pharmacotherapy of obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Psychiatr Clin North Am, 2006;29:553-584, xi.