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Terms in this set (16)

Medications most commonly prescribed for OCD are antidepressants called selective serotonin reuptake inhibitors (SSRIs), notably, fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Aropax), fluvoxamine (Luvox), and citalopram (Celexa).

Another medication used is clomipramine (Anafranil), which is a non-selective SRI, meaning it affects other neurotransmitters besides serotonin, and might have more side effects.

The SSRIs are usually easier for people to tolerate. All these antidepressants are equally effective, although for any particular person one agent may be better than another.

Most people notice some benefit from these medications after four to six weeks, but it is necessary to try the medication for 10 to 12 weeks to see whether it works or not. If you do experience distressing side-effects, your doctor can try reducing the dose, or adding or switching to a different medicine. Indeed, when the medication (an SSRI) has proved ineffective after 10 to 12 weeks, a different SSRI can be tried. Alternatively, another medication can be added to the first, or adding CBT may render treatment more effective.

Very importantly: Before deciding that a treatment has failed, your therapist needs to be sure that the treatment has been given in a large enough dose for a sufficient period of time.

Fewer than 20% of people treated with medication alone will have their symptoms resolved completely, so medication is often combined with CBT for better results. The need for medication depends on the severity of your OCD and your age. In milder OCD, CBT alone may be used initially, but medication may be added if CBT proves ineffective. People with severe OCD or complicating conditions (such as depression) often start with medication, adding CBT once the medicine has provided some relief. In younger patients doctors are more likely to use CBT alone. However, if a trained cognitive-behavioral psychotherapist is unavailable, medication may be used.
Behaviour therapy helps you learn to change your behaviour and feelings by changing your thoughts. Behaviour therapy for OCD involves exposure and response prevention (E/RP), and cognitive therapy.

Exposure involves gradually exposing yourself to feared stimuli. For example, people with contamination obsessions are encouraged to touch "dirty" objects (like money) until their anxiety recedes. Anxiety tends to decrease after repeated exposure until the contact is no longer feared.

Exposure is most effective if combined with response or ritual prevention, in which rituals or avoidance behaviours are blocked. If, for example, you wash your hands compulsively, your therapist may stand at the sink with you and prevent you from washing your hands until the anxiety recedes.

Cognitive therapy, the other component in CBT, is often added to E/RP to help reduce the exaggerated thoughts and sense of responsibility that often occurs in OCD. Cognitive therapy helps you challenge the faulty assumptions of your obsessions, and so bring anxiety and the urge to respond with compulsive behaviour under control.

Gradual CBT involves practice with the therapist once or twice a week and doing daily E/RP "homework". Homework is necessary because many of the elements that trigger OCD occur in your own environment and often cannot be reproduced in the therapist's office. According to research, people who complete CBT have a 50%-80% reduction in symptoms after 12-20 sessions. Intensive CBT, which involves two to three hours of therapist-assisted E/RP daily for three weeks, may work even more quickly. In rare cases where OCD is very severe or complicated by another illness, or involves severe depression or aggressive impulses, hospitalisation may be recommended for intensive CBT.

Other techniques, such as thought stopping and distraction (suppressing or "switching off" OCD symptoms) may sometimes be helpful.