MANAGEMENT OF OCD

This is achieved using pharmacologic (medical) and/or non-pharmacologic (non-medical) approaches.

1) Pharmacologic

The main types of medicine you are likely to receive for treatment of OCD are the selective serotonin reuptake inhibitors (SSRIs) or a tricyclic antidepressant (TCA) with strong serotoninergic action (clomipramine). As abnormal quantities of a neurochemical called serotonin is implicated in the pathogenesis of OCD, the use of these antidepressants that specifically act on the serotonin receptors can improve OCD. Examples of these antidepressants include fluvoxamine, fluoxetine, sertraline, paroxetine, escitalopram and clomipramine.

Although these medicines are effective in improving OCD, they may cause side-effects in certain individuals. This is because many of the antidepressants are used in higher doses when treating OCD. These include nausea, loose stools, abdominal discomfort and headaches. These side-effects usually go away after a few days of taking the medicine. In certain more treatment resistant cases, the psychiatrist will use other types of antidepressants, a combination of antidepressants, or augmentation with an antipsychotic. Besides treating OCD, antidepressants can also treat any secondary depression that you may have.

2) Non-Pharmacologic

Cognitive behaviorial therapy (CBT) is useful for treatment of OCD. It may be used alone (for mild cases of OCD) or in combination with medicines. The specific technique employed in treatment of OCD is exposure and response prevention (ERP). Here you will learn to gradually tolerate the anxiety associated with not performing the compulsive behaviour.

For example, consider an individual with obsessive fear of contamination by germs and has compulsive handwashing: he or she is prevented from washing the hands after exposure to a contaminated surface such as touching a door knob. As the individual habituates to this exposure and anxiety drops, he or she can proceed to exposure to something more “contaminated”, again with response prevention. For those with only mental obsessions without much physical compulsions, techniques such as thought-stopping are also useful. In CBT, you are expected to do “homework”, i.e. practice the skills learnt at home, hence it is important for you to be highly motivated.

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Expert Author:

Dr Thong Jiunn Yew, Nobel Psychological Wellness Clinic