Note: The following is presented for informational purposes only. Assessment and treatment should always be directed through one-on-one consultation with a trained professional.

There are two forms of effective treatment for OCD: Cognitive Behavioral Therapy (CBT) and Medications.

Cognitive Behavioral Therapy for OCD

The most effective and well-documented psychotherapy for OCD is Cognitive Behavioral Therapy. Approximately 70% of patients respond to CBT for OCD and the effects appear to be more robust and more long-lasting than medication treatment alone.

The primary technique used in CBT for OCD is Exposure and Response Prevention - this involves mildly triggering obsessions and abstaining from doing rituals until the impulse to do so subsides. The key to the treatment is to find something very easy to start with. This treatment is done gradually so as not to produce too much anxiety during any one exposure. The entire treatment typically takes 10-16 weeks to complete.

Medications for OCD

Medications are also effective for OCD (i.e. ~70% of patients respond to the first medication they try, and ~90% of patients respond if they eventually try three different medications overall). The most frequently used medications are the antidepressants known as Selective Serotonin Re-uptake Inhibitors (i.e. SSRI's). There are currently 6 SSRI's: Prozac, Luvox, Paxil, Zoloft, Celexa, and Lexapro. Each of these medications appears to be equally effective, so the choice of medication is often based on other considerations (i.e. Is it sedating or energizing?, Does it interact with other medications?). For OCD, these medications typically take 6-12 weeks to kick-in.

The most effective medication for OCD is actually a much older medication then the SSRI's - a Tricyclic Antidepressant called Clompiramine (Anafranil). A slightly larger percentage of patients appear to respond to this medication compared to SSRI's, however we usually don't prescribe it first because it has more side effects and the side effects tend to linger during treatment rather then gradually disappearing the way most SSRI's side effects do.
A class of medications known as Atypical Neuroleptics (i.e. Risperdal, Seroquel, Geodon, and Zyprexa) appear to be helpful for OCD when they are added onto antidepressants. These medications are typically added on if a patient has responded to an antidepressant, but some significant symptoms still remain.

Combining Medications and CBT for OCD

A recent meta-analysis* of treatment studies suggests that the combination of Medications and CBT is more effective than either treatment alone.  The American Psychiatric Association's current practice guidelines echo this fact but also note that trying either treatment alone is a reasonable alternative..

I usually recommend that patients with mild OCD symptoms try CBT alone first. In contrast, I usually advise patient with moderate to severe symptoms, or patients who have not responded to CBT alone, or patients who want the best chance of getting relief from their symptoms right off the bat to start both medications and CBT, with the plan to taper off of medications once the CBT is completed. If patients have a strong feeling about just trying CBT alone or just trying Medications alone, I support whatever they want to try and give them feedback on how things are progressing as we move along.

*Eddy KT, Dutra L, Bradley R, Westen D., A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clinical Psychology Review. 2004 Dec;24(8):1011-30.

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