What treatments are available?
Before you have any treatment, your doctor should discuss all your treatment options with you, and your views and wishes should be taken into account.
Cognitive behaviour therapy (CBT)
“CBT techniques helped me to see the intrusive thoughts for what they are, and put them in their place.”
Cognitive behavioural therapy (CBT) is a talking treatment which aims to identify connections between your thoughts, feelings, and behaviour. It aims to help you develop practical skills to manage any negative patterns of thinking or behaviour that may be causing you difficulties. It can be done one-to-one, or in a group. There is considerable evidence to suggest that this kind of therapy is especially effective in dealing with OCD.
The behavioural element (also known as Exposure Response Prevention – ERP) is strongly recommended for treating OCD. ERP works by helping you to confront your obsessions and resist the urge to carry out compulsions. The aim is to help you feel less anxious about obsessive thoughts over time, and make you less likely to engage in compulsive behaviour. For example, if you fear that you will harm someone and avoid sharp objects as a result, you might build up to a therapy session where you hold a knife while sitting in a room with other people.
This technique needs to be carefully managed to avoid causing distress and anxiety, so it is important that you understand the treatment fully and feel comfortable with your therapist.
“It’s hugely frustrating and exhausting trying to break out of patterns that you know aren’t helpful or healthy. It can feel hopeless. But by challenging the behaviours, thoughts or compulsion you can eventually achieve fresh change that seemed impossible.”
Some people find drug treatment helpful for OCD, either alone or combined with talking treatments, such as cognitive behaviour therapy (CBT).
“I’ve been on meds for the last three years and my OCD is so much more controllable.”
Before taking any medication, it is important to read the patient information leaflet (that comes with the medicine) and discuss possible benefits and side effects with your doctor.
The drugs prescribed most commonly are Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants, such as:
- Fluoxetine (Prozac)
- Fluvoxamine (Faverin)
- Paroxetine (Seroxat)
- Citalopram (Cipramil)
- Sertraline (Lustral)
These drugs are all recommended by the National Institute for Clinical Excellence (NICE) for the treatment of OCD. These drugs may have side effects, including nausea, headache, sleep disturbance, gastric upsets and increased anxiety. They may also cause sexual problems.
The tricyclic antidepressant clomipramine (Anafranil) is also licensed for the treatment of obsessional states in adults. This should normally only be prescribed if an SSRI antidepressant has already been tried and not been effective. The side effects of clomipramine can include a dry mouth, blurred vision, constipation, drowsiness and dizziness.
If you are experiencing very severe anxiety as a result of OCD, you may be offered tranquillising drugs, such as diazepam (Valium). This type of medication should only be used for short periods of treatment because of the risk of addiction. The side effects of tranquilisers can include drowsiness, confusion, unsteadiness and nausea.
Beta-blockers are occasionally given to people to treat the immediate symptoms of severe anxiety. They do not treat the anxiety itself, but act on the heart and blood pressure to reduce physical symptoms, such as palpitations. The beta-blocker most commonly used for anxiety is propranolol (Inderal). The main side effects include a slow heartbeat, diarrhoea and nausea, cold fingers, tiredness and sleep problems.
Neurosurgery for mental disorder
Neurosurgery (previously known as psychosurgery) is surgery on the brain. It is not recommended for treating OCD, but is very occasionally offered in severe cases, when other treatments have been unsuccessful. Neurosurgery is strictly regulated under the Mental Health Ordinance, and cannot be given without consent.