Medication and OCD
Because Exposure and Response Prevention therapy can be challenging, medication is sometimes prescribed to manage the level of anxiety.
Cognitive Behavior Therapy has been shown to have many benefits over medication alone. It tends to be faster-acting and more cost-effective over time, for example, and it doesn’t involve the risk of side effects. Furthermore, studies have consistently shown that the positive gains associated with CBT are longer-lasting than those of medication; relapse rates are lower when CBT is discontinued than when medication is stopped.
But for some people with OCD, a combination of CBT and medication is the most effective treatment. Medication may be prescribed by a doctor, for example, for those who have moderate to severe OCD or OCD with co-existing depression. It can decrease levels of distress and help people succeed in therapy. In fact, medications are often used on a temporary basis until the person is able to manage the disorder with therapy alone. Once the patient is better able to handle anxiety and stress during CBT, medication may be gradually reduced and, in some cases, eliminated.
Unfortunately, many people with OCD don’t have access to CBT for a number of reasons: location (e.g., individuals in rural areas may have to travel long distances to find a qualified CBT therapist); financial issues (e.g., an insurance company may not cover the cost of CBT and families cannot afford to pay for it out of pocket); and a lack of professionals who are trained in CBT. In addition, some individuals are unwilling to participate in CBT (e.g., they don’t see the senselessness of their obsessions and compulsions), or they don't respond to CBT. In these cases, medications may need to be prescribed to treat OCD. Fortunately, many individuals are more willing and able to participate in CBT after being on medication for a period of time.
Antidepressants classified as serotonin reuptake inhibitors, which include serotonin-specific reuptake inhibitors, have been shown to be the most effective medications for most people – both children and adults – with OCD. Because body chemistry differs so much across individuals, the type and dosage of medication prescribed will vary. Some people with OCD respond well to the first drug prescribed; others must try more than one (under close medical supervision), to find the medication that produces the best results.
Most of these medications do not produce immediate relief from OCD symptoms. Some may begin to work after a few weeks, but it may take 10 to 12 weeks at therapeutic doses to be effective. In fact, many people experience only side effects during the first few weeks of treatment. But after a period of time, they may see a big improvement in their symptoms. CBT may begin at any time after medication is prescribed, depending on the person’s reaction to the drugs.
The best way to enhance the effectiveness of medication is to add Cognitive Behavior Therapy to ongoing drug treatment. But when individuals with OCD don’t respond to CBT and trials with a number of different SSRIs, clinicians sometimes add another drug to boost a particular medication’s effectiveness, overall. This is known as augmentation therapy.
It’s important to work with a physician (for example, a psychiatrist) who is experienced in prescribing and monitoring different medications for OCD. The physician should advise patients about the possible side effects of medications, assess their effectiveness, and, if appropriate, provide instructions for tapering off the dosage. SSRIs should never be discontinued abruptly.