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Obsessive-Compulsive Disorder: What Works?!

How Do You Treat Obsessive-Compulsive Disorder?

“Okay, Bill. You described what OCD looks like. And you dialed-me-in on its anatomy and physiology. So tell me how to manage it!”

Fair enough, let’s get on it. First, here are links to Part 1 (description) and Part 2 (anatomy/physiology) of the series.

Psychotherapy/Exposure and Response Prevention (ERP)

Cognitive Behavioral Therapy (CBT) works well for obsessive-compulsive disorder (OCD). It’s thought that those who benefit from CBT see a 70% improvement in symptoms. Click here for a thorough CBT description.

Exposure and Response Prevention (ERP)

The foundation of exposure and response prevention (ERP), a CBT, is confronting the thoughts, images, objects, and situations that generate anxiety – the obsessions. That handles the exposure part. The response piece is intended to help the individual make a choice not to perform a compulsive behavior in response to an obsession.

ERP is strong because the individual makes a commitment not give-in and perform the compulsive behavior until a reduction in anxiety is sensed.

The foundation is solid. Continuing to perform compulsions reinforces the generation of obsessions/anxiety. I mean, if the mind learns that a compulsion automatically follows an obsession – and provides anxiety relief – why wouldn’t it continue with business as usual?

So as with anything anxiety, the task is to secure and act upon rational thought. You really do know you’re not in danger, so it’s time to “train the brain.”

Medication

Those who benefit from medication experience a symptom reduction of some 50%. It’s important to understand, though, that using both medication and ERP is the very best option.

The most prescribed meds for OCD treatment are the antidepressants. They may even offer a 2 for 1 special because in addition to providing relief for OCD, they also address associated depression.

For all sorts of antidepressant information, including side effects, click here to read the first in my Need-to-Know Antidepressant series.

Not all of the antidepressants work well for OCD. The ones that do are…

  • Selective Serotonin Reuptake Inhibitor (SSRI) – fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro)
  • Tricyclic (TCA) – clomipramine (Anafranil)
  • Serotonin Norepinephrine Reuptake Inhibitor (SNRI) – venlafaxine (Effexor)

Other Treatments

If an ERP and meds combo don’t do the job, there are alternatives. Again, these are options, not first-line therapies.

Brain Surgery

In Tuesday’s piece I mentioned an OCD-significant brain structure known as the cingulate gyrus. Well, a procedure known as an anterior cingulotomy burns an area within the anterior cingulate cortex. Some 50% receive benefit.

Anterior capsulotomy is similar, but involves the anterior limb of the internal capsule. Some 50-60% receive benefit.

Gamma Ventral Capsulotomy

Multiple gamma rays pass through the skull creating enough energy to destroy brain tissue. In this case it’s the bottom half of a brain area known as the anterior capsule. Gamma knife procedures don’t require opening the skull. Some 60% receive benefit.

Deep Brian Stimulation (DBS)

In a DBS procedure, electrodes are placed in targeted brain areas. Current placement is at the ventral capsule/ventral striatum (VC/VS). When in place, the electrodes are connected by wires under the skin to pulse generators (implantable neurostimulators) under the skin between the collarbones.

A physician uses a hand-held wand and a small computer to control the pulse generator through the skin. It’s similar in principle to a heart pacemaker.

The initial results of DBS are promising, but there haven’t been enough procedures to tell the tale.

Medications/Glutamate

Most know about the role of the neurotransmitters serotonin, norepinephrine, and dopamine in the mood and anxiety disorders. But the neurotransmitter glutamate is getting lots of attention – especially with regard to OCD.

Glutamate is our most abundant excitatory neurotransmitter. Abnormal levels of glutamate may be a factor in OCD.

It seems as though glutamate-targeting medications merit a look-see for the treatment of OCD. And researchers are doing clinical trials using FDA approved drugs for other medical conditions – Riluzole (Rilutek) and memantine (Namenda). N-acetylcysteine (NAC), an antioxidant available without prescription, also shows promise.

Over & Out

What a wrap for our OCD series! I hope you found it meaningful and helpful. Obsessive-compulsive disorder is tricky business. And, unfortunately, treatment so often doesn’t happen because of embarrassment, lack of understanding, and unqualified emotional and mental health professionals.

But openness and education, as well as use of the magic word – rational – will quickly bring us up to speed.

P.S. Never give up!