Anti-Obsessional Medication

Effective treatments for OCD are now readily available. There are two main treatment approaches: Treatment with medication and behavioural or cognitive therapy. Generally a combination of these approaches is used backed up with support and education about the condition.

The medication may be used either alone or in combination with cognitive behaviour therapy. Although your general practitioner can prescribe this medication, they may refer you to a psychiatrist.

The medications that are beneficial in treating individuals with OCD have specific marked effects on the serotonergic system and are all well known antidepressants.

More than half of those with OCD also suffer from depression, but it appears that the medications that are effective in OCD have a specific anti - obsessional effect independent of an effect on depressive symptoms. The evidence points to the depression being an integral part of the illness. The depression improves only as the OCD improves. It is therefore important that the OCD is treated appropriately.

Biological explanations of OCD emphasise that a chemical imbalance of a substance called serotonin may occur in the brain. Treatment consists of certain anti-obsessional medications that are strongly 'serotonergic' (This basically means that they have an effect on serotonin).

About 60% of patients with OCD improve with medication. In order to know whether you respond, you may have to take a high dose of the drug for at least 12 weeks.

Clomipramine (Trade name 'Anafranil') was the first anti-obsessional drug available in the UK but this is less commonly prescribed now. The dose required may be quite high (250mg or more) and this can lead to some side-effects including dry mouth, blurred vision, constipation, drowsiness, dizziness on standing, and inability to reach orgasm.

The newer selective serotonin reuptake inhibitor (SSRI) drugs are more widely prescribed. These include: Fluoxetine (Trade name 'Prozac'), Fluvoxamine ('Faverin'), Sertraline ('Lustral'), Paroxetine ('Seroxat') and Citalopram ('Cipramil'). All these drugs can be effective but one person may get a better response to one than another. As a result, at least three are usually tried before concluding that they have no benefit.

• Fluvoxamine was the first of the SSRIs available in the UK. Doses of 150-300mg daily have been found to be effective in the treatment of OCD.

• Fluoxetine is effective in the treatment of OCD in doses between 20mg and 60mg daily although there is evidence that a larger number of people respond to the higher dose.

• Paroxetine has been shown to be effective in the treatment of OCD. The minimum effective dose in OCD is 40mg daily which is higher than is usually used in depression. Doses of 40mg to 60mg daily are used for OCD.

• Sertraline is effective in OCD in doses from 50-200mg. There is some evidence that higher doses are needed in some sufferers. Although it does not yet have a licence for OCD in the UK it is clearly effective.

• Clomipramine is one of the older antidepressants and has been available for many years. Although it is widely used in treating OCD it does not have a specific licence for OCD in the UK. Some people have difficulty taking clomipramine because of side effects such as dry mouth, blurred vision, constipation, tiredness, dizziness, inability to reach orgasm.

In individuals who do not respond, a major tranquilliser may also be prescribed, such as: Risperidone (Trade name in UK 'Risperidal'), Haloperidol ('Haldol') or Sulpiride ('Dolmatil').

These drugs are probably only useful in a low dose in a few patients, as an additional treatment to anti-obsessional drugs, and after a number of anti-obsessional drugs have been tried fully. They are not thought to be helpful if used alone. They have different side effects such as stiffness in the limbs or slurred speech that can be countered by other medication. In low doses the drugs may help to reduce anxiety. In more severe cases, there are other drugs that may be added to improve the response.

SSRIs tend to produce fewer side effects to clomipramine. With these drugs a minority of people may experience nausea, diarrhoea, headache, difficulty in sleeping, restlessness or difficulties in reaching orgasm. Most people find the side effects are minor irritations that usually decrease after a few weeks. Although you may stop taking SSRIs whenever you wish, it is sensible to reduce them under supervision.

Relapse is common when medication is withdrawn. However, the risk of relapse can be minimised by combining the medication with CBT. Individuals who have repeated episodes of OCD may need to receive longer term medication.

Don't be afraid to ask for a second opinion where necessary. In some cases, traveling to a specialised centre that provides intensive CBT or specialist advice on medication may be the most practical solution.

The effect of no treatment
Without any form of treatment, an individual with OCD will most likely spend their lives under a great deal of stress. Those patients who do make the decision to either postpone or forgo treatment usually experience a worsening of symptoms, which in turn decreases their ability to function on a day-to-day basis.

Self - Help
If the OCD is not severe sufferers can start their own self - help programme. A number of books setting out self - help programmes are available from our OCD Shop. (Examples are 'Understanding obsessions and compulsions: A self - help manual' by Frank Tallis and 'Living with Fear' by Isaac Marks).

It is important to set aside time to follow a programme and to follow a programme consistently. The family can help by providing encouragement for the sufferer and praise when changes are achieved.

If the problem is more severe or complicated, the sufferer will benefit from seeking professional help. The GP may make a referral to a specialist for behaviour therapy.

Support groups
Support groups can potentially be a useful part of treatment. These groups provide a forum for mutual acceptance, understanding and setting of goals. People new to OCD can talk to others who have learned successful strategies for coping with the illness. It is important to remember, however, that support groups are not suitable for everyone.

UK Support Groups

Source: OCD Action 2002