Support & Info

Treatments Available

September 7, 2009

Treatments & Therapies Available

There are two main treatments for OCD – Cognitive Behavioural Therapy (CBT) and Anti-Obsessional Medication. Habit Reversal Therapy is also used by some professionals.

CBT and medication can be used alone or in combination with one another. CBT is often recommended as a first line of treatment; medication as a second line of treatment when an individual fails to make progress with CBT, or if an individual has severe problems, or is significantly depressed. However, there are often long waiting lists for CBT on the NHS and you may be offered medication as a first treatment by your GP or Consultant. The choice, however, is yours.

For most people with OCD professional help will be needed at some time. This usually means working with a a psychiatrist, psychologist or a nurse therapist. If you think you need professional treatment, your general practitioner (GP) is usually the best place to start. Your GP may refer you to a psychiatrist. You should be aware that not all GPs know about OCD. OCD Action has created our ‘GP Information Card’ specifically for this purpose. Please contact the office to receive a copy. If you are worried about seeing your GP, you could take a friend along with you, ask OCD Action to forward an information pack directly to your GP or take along a and/or the GP Information Card yourself. In the unlikely event that your GP refuses to give you any treatment or refer you for cognitive behavioural therapy, you can get advice from your Citizens Advice Bureau or the General Medical Council.

Even if you do get referred to mental health services, you need to remember that waiting lists are likely to be long. However, your GP should have provided some support while you are waiting, such as medication. Treatment does not work for everybody, but it rarely makes symptoms worse. It is common for people to be given a combination of treatments, such as medication and cognitive behaviour therapy. You may have to persevere to find treatment that works for you. Research shows that about 75% of people treated for OCD find it beneficial.

People with OCD can often be afraid or embarrassed to go to their GP for treatment. It is common for people with OCD to hide their symptoms for many years. However difficult it feels to tell other people, you should remember that hiding the symptoms will not help you cope with OCD and that your GP will have an understanding of psychological disorders and is there to help you. To help you explain what you feel, you could write down the main points beforehand. All the information that you tell your GP is confidential and cannot be shared without your permission. OCD is often referred to as an ‘anxiety disorder’ or a ‘psychological condition’. Sometimes, the term ‘mental illness’ is used. If you are worried about job applications that ask about ‘mental illness’, talk to your GP.

In addition to professional help, self-help groups, books, leaflets and the Internet are useful ways of learning how to cope with OCD. The more you know about OCD, the better equipped you will be to deal with it.

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Medication

September 3, 2009

Biological explanations of OCD emphasise the role of the brain chemical serotonin. Treatment consists of certain anti-obsessional medications that are strongly ’serotonergic’ (this basically means they have an effect on serotonin). The medication may be used either alone or in combination with cognitive behaviour therapy.

Although a person’s general practitioner can prescribe this medication, s/he may refer the person to a psychiatrist.

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

The newer selective serotonin reuptake inhibitor (SSRI) drugs are more widely prescribed. These include: Fluoxetine (trade name ‘Prozac’); Fluvoxamine (’Faverin’); Sertraline (’Lustral); Paroxetine (’Seroxat’); Escitalopram (’Cipralex’) 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.

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.

In individuals who do not respond to anti-obsessional drugs, other medications 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 already 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 than 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 the patient may stop taking SSRIs whenever s/he wishes, it is sensible to reduce them under supervision.

If you have any concerns regarding your medication, please speak to your GP or whoever prescribed the treatment.

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