Many experts believe that Cognitive Behavior Therapy tends to be a faster-acting and more cost-effective treatment for OCD over time than medication, and it doesn’t involve the risk of side effects. Moreover, studies have consistently shown that the positive effects of CBT are longer-lasting than those of medication: relapse rates are lower when CBT is discontinued compared with relapse rates when medication is terminated.
For some people with OCD, however, a combination of CBT and medication is the most effective treatment. Medication may be prescribed by a physician, for example, for those who have moderate to severe OCD or OCD with comorbid 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 manage anxiety and stress during CBT, the medication may be gradually reduced and then eliminated.
Unfortunately, a large number of individuals with OCD are unable to access CBT because of 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. Furthermore, 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, medication may need to be prescribed to treat OCD. Of note is that 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 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 symptom relief. Some may begin to work after a few weeks, but it may take 10 to 12 weeks at therapeutic doses to be effective. Many patients feel no positive effects for the first few weeks of treatment. In fact, they may only experience side effects. 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 behavior therapy to ongoing drug treatment. When individuals with OCD are unresponsive to CBT and trials with a number of different SSRIs, however, 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 and can assess their effectiveness. The physician should also advise patients about possible side effects and, if the medication must be discontinued, provide instructions for tapering off the dosage. SSRIs should never be discontinued abruptly.