Many experts believe that Cognitive Behavior Therapy (CBT) 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. In addition, studies have indicated that as many as 85% of people who complete CBT experience a significant reduction in symptoms; the success rate for medication is substantially lower. Moreover, research has consistently shown that individuals with OCD experience lower relapse rates when CBT is discontinued, as compared with relapse rates when medication is stopped.
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 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 cope with anxiety and stress during CBT, the medication may be gradually reduced and then eliminated.
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.
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.
If your college’s or university’s student health center or counseling service refers you to a doctor to receive medication for OCD, request that you also be referred to a cognitive behavior therapist for CBT. Remember that CBT is still the “gold standard” for the treatment of OCD – with proven, long-lasting results unmatched by medication alone.
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