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OBSESSIVE-COMPULSIVE DISORDER

Pharmacotherapy

The SSRIs
Following earlier studies in which clomipramine was found to have anti-obsessive properties, the SSRIs have been commonplace in the treatment of OCD, likely because of their acceptable side effect profile. There are no significant differences between the SSRIs in their effect on OCD, and all SSRIs are currently indicated for OCD, including nefazodone.

Venlafaxine
Preliminary reports indicate the venlafaxine may be helpful in OCD, particularly in patients with comorbid depression.

Buspirone
Results of studies evaluating buspirone in OCD as primary or augmentation therapy have been mixed, and its use in OCD has yet to be clarified.

Outcome
OCD can be difficult to resolve and the use of medication plus Cognitive Behavioural Therapy (see below) may not fully banish all obsessive thoughts and ritualistic behaviors. But for 60 to 80% of people with OCD, treatment will diminish the intensity of the disorder and allows people to have a life - often for the first time in years.

 

OCD Pharmacotherapy: Dosages

Drug Class Drug Starting dose Usual dosage range
SSRIs fluoxetine 20 mg/day 20-80 mg/day
fluvoxamine 50 mg/day 100-300 mg/day
paroxetine 10-20 mg/day 20-60 mg/day
sertaline 25-50 mg/day 50-200 mg/day
Tricyclics clomipramine 25 mg/day 100-300 mg/day

 

Cognitive Behavioural Therapy

Cognitive behavioral therapy (CBT) and pharmacological intervention with SSRIs, for example, can significantly enhance function and relieve distress in about 80% of OCD patients. CBT works by teaching patients how to systematically alter their compulsive responses to obsessive thoughts, while antidepressants decrease the intensity of intrusive OCD symptoms over a period of 2 to 3 months.

It may take 6 to 10 weeks before the patient notices any change in symptoms, and typically 12 weeks before maximal benefits are obtained. Once patients have been stabilized on medical therapy for 3 months or more, the dosage may be gradually reduced.

Although OCD thoughts and urges are not completely gone from the patient's inner life, after about 3 months of medication, patients usually find that the effort to ignore them is lessened considerably.

By teaching people specific techniques aimed at helping them to "unlearn" and reverse obsessive, compulsive behaviour, CBT is often successful in helping defuse obsessions and compulsions so that even if troubling thoughts intrude, people no longer feel compelled to respond to them.

 

Cognitive Behavioural Therapy for Obsessive Compulsive Disorder

Step 1: Relabel

• Recognize that the intrusive obsessive thoughts and urges are the result of OCD
Step 2: Reattribute
• Realize that the intensity and intrusiveness of the thought or urge is caused by OCD and is probably related to a biochemical imbalance in the brain
Step 3: Refocus
• Work around the OCD thoughts by focusing attention on something else, at least for a few minutes; do another behavior
Step 4: Revalue
• Do not take the OCD thought at face value; it is not significant in itself

 

NB: These steps are explained in detail as part of a patient, self-treatment program outlined in Brain Lock: Free yourself from obsessive-compulsive behavior by Jeffrey M. Schwartz. (New York, Harper Collins, 1997).

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Over one million Canadians suffer from some form of depressive illness.