Obsessive-Compulsive Disorder Treatment Program Options
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Obsessive-compulsive disorder (OCD), as defined by the Mayo Clinic, is classified as a type of anxiety disorder. People with OCD are driven by unreasonable thoughts and unwarranted fears, referred to as “obsessions,” to perform repetitive behaviors, referred to as “compulsions.” People suffering from OCD might understand their obsessions are unreasonable, but trying to stop or ignore them causes compounding anxiety and stress. The repetitions must ultimately be reinstated to alleviate mounting stressful feelings and anxiety.
Statistics from the Department of Psychiatry at the University of California, San Diego (UCSD) lists OCD as the fourth most common neuropsychiatric illness in the US. At any given time, more than 5 million Americans are living with the symptoms of OCD. That is one in 40 adults and one in 200 children.
What Causes OCD?
Although what causes obsessive-compulsive disorder is not fully known, three theories have been developed. OCD may have a biological basis and be the result of changes in a person’s higher cognitive functions brought about by neurochemical imbalances. Specific genes responsible for OCD have not been identified. The second theory is that OCD may be caused by environmental factors and be born of behavior-related habits a person has been learning over time.
The third theory blames OCD on insufficient serotonin levels. Serotonin is a neurotransmitter; it is one of the brain’s chemical messengers. Medications that work by improving serotonin action reduce obsessive-compulsive disorder symptoms, which lends much credence to this theory.
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Is There a Cure for OCD?
There is no cure for obsessive-compulsive disorder, but there are methods of treatment that provide relief from the symptoms to the extent that most patients can lead normal lives. Treatment-resistant OCD does not seem to respond to therapies; however, all OCD cases were once considered resistant to treatment. After further study, it is now possible to treat 40 to 60 percent of OCD patients using medication alone, and new information emerges as treatments progress, according to the National Center for Biotechnology Information (NCBI).
Therapies for OCD
Therapies for obsessive-compulsive disorder typically consist of medication, psychotherapy or both. OCD responds well to cognitive behavioral therapy. This type of therapy coupled with prescribed medication, usually antidepressants or anti-anxiety medications, alleviates the symptoms for most people who suffer from OCD.
Cognitive Behavioral Therapy Treatment for OCD
Cognitive behavioral therapy treatment for OCD may take place in individual, group or family sessions. OCD patients can experience some relief through cognitive behavioral therapy, particularly a form called exposure and response prevention. This entails gradually exposing the patient to the feared obsession. For instance, if the patient is obsessed with cleanliness, they are exposed to dirt for gradually increasing amounts of time. This helps the patient to learn new thought patterns and behaviors about their obsession with dirt. Although this form of therapy takes a lot of effort and practice, the reward is a much better quality of life for the patient.
The basic premise behind exposure and response prevention is that compulsion allows obsession to exist by interrupting the habituation process. The process of habituation is what causes a person to have less interest in a certain event once that person has witnessed the same event many times. For example, if your friends threw you a surprise party every day, you would eventually stop being surprised and thrilled. In the same manner, if the compulsion did not exist, the obsession would become less and less interesting until it eventually disappeared. Once a compulsion is fulfilled by an obsession, the person feels short-term relief of anxiety. The relief serves to reinforce the compulsion like a reward, and it becomes a perpetual cycle. Simply put, without compulsion, obsession would not occur and vice versa.
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Medically Assisted OCD Therapy
The National Library of Medicine (NLM) lists medications commonly prescribed in medically assisted OCD therapy. The most effective medications prescribed for obsessive-compulsive disorder are selective serotonin reuptake inhibitors (SSRIs), which are antidepressants. These medications include:
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac)
- Citalopram (Celexa)
If a patient fails to respond to an SSRI, doctors revert to clomipramine. Clomipramine is an older tricyclic antidepressant and was the first medication used to treat OCD. Although its efficacy is greater than that of other medications, it has unpleasant side effects that may make the patient uncomfortable. Sometimes an SSRI and clomipramine are combined in treatment. The side effects of clomipramine include:
- Sleepiness
- Drop in blood pressure when rising from a seated position
- Difficulty starting urination
- Dry mouth
Atypical antipsychotics have also proven to be helpful in low doses. Among these antipsychotics are:
- Risperidone
- Quetiapine
- Olanzapine
- Ziprasidone
In some cases, benzodiazepines can offer anxiety relief, but they are typically only used in conjunction with more reliable treatments. Cognitive therapy is the preferred form of treatment, but many patients benefit from combining medication with therapy.
Psychosurgery
Psychosurgery is used to alleviate symptoms of obsessive-compulsive disorder in patients who do not respond to medications or behavioral therapy. As per the International OCD Foundation, four types of brain surgery have proven effective in treating OCD. The first is anterior cingulotomy. This surgery involves drilling into the skull and burning an area of the brain called the anterior cingulate cortex with a heated probe. This surgery has provided benefits for 50 percent of those with treatment-resistant OCD.
The second surgery is known as anterior capsulotomy. This surgery is similar to the anterior cingulotomy surgery, but doctors operate on a different area of the brain called the anterior limb of the internal capsule. The surgery has succeeded in giving relief to 50 to 60 percent of patients with treatment-resistant OCD.
The third procedure is called the gamma knife. This treatment does not involve opening the patient’s skull. Rather, the skull is penetrated by multiple doses of gamma rays. While a single dose of gamma rays will not harm brain tissue, when multiple sources of gamma rays intersect, they create an energy level adequate to destroy targeted brain tissue. The gamma knife procedure has been helpful to about 60 percent of treatment-resistant OCD patients.
Finally, there is deep brain stimulation (DBS). Although this procedure requires opening the patient’s skull, it does not involve destroying brain tissue. Instead, electrodes are placed at strategic points inside the brain and wired to a pulse generator. The battery-powered generator, also called an implantable neurostimulator, sends pulses to the brain. It works in a similar fashion to a pacemaker. So far, only small studies have been conducted with deep brain stimulation, but the response rate is similar to the other surgeries.
Other Therapeutic Methods
Intensive treatment programs are available. Some programs last only a weekend while others require a three-month stay at a treatment center. At these facilities, OCD patients undergo intensive individual, group and family cognitive therapy every day. A specifically devised medication regimen is also used. Other therapeutic methods are in development. Research involving the manipulation of neurotransmitters is currently under way.
The National Alliance on Mental Illness (NAMI) discusses the use of electroconvulsive therapy (ECT). During ECT, the psychiatrist uses a machine to deliver electric shocks to the brain of the patient. The shock triggers a controlled seizure to activate neurons that bring about changes in neurochemical levels in the brain. This method is very effective for OCD.
Transcranial magnetic stimulation utilizes magnetic fields to stimulate the nerve cells in the patient’s brain. This process decreases the severity of some symptoms of depression. The method is used when others fail.
Residential and Inpatient OCD Treatment Centers
Residential or inpatient OCD treatment centers are available for patients who do not respond to other therapies. They offer hospital and residential care, and some centers conduct research. These centers offer in-depth, structured therapy and psychopharmacological approaches.
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The Benefits of Residential OCD Treatments
The benefits of residential OCD treatments are not limited to intensive inpatient and outpatient treatment. The residential centers are valued for their research and for providing treatment programs far more tailored to each patient’s needs. Comorbid conditions are also diagnosed and treated, and some centers offer traditional care along with intensive therapy.
Luxury OCD Disorder Facilities
Luxury OCD treatment facilities offer such amenities as forward-thinking rehab, expert staff members, gourmet chefs, exotic activities and pristine grounds. Some are akin to resorts, and some unite Eastern spiritual practices, like meditation and yoga, with traditional therapy.
Executive OCD Disorder Programs
As with luxury treatment facilities, executive OCD programs offer a wide array of high-class amenities. The major difference is that these programs are geared toward business executives and corporate managers who cannot attend a full-time residential program, and who need to be able to carry on with their business affairs while in treatment.
Outpatient OCD Rehab and Treatment Programs
Outpatient OCD rehab and treatment programs offer intensive outpatient treatment conducted by dedicated staff members. They assist individuals with OCD as well as their families. Many of these facilities conduct research into OCD and use research-based treatment options.
Prescription and Over-the-Counter Medications
According to the International OCD Foundation, medication can reduce symptoms of OCD by 40 to 60 percent in most patients. The majority of drugs used to treat OCD are antidepressants, as depression often stems from the effects of OCD. Both disorders can be treated with one medication. Not all antidepressants are effective for OCD symptoms. There are eight antidepressants known to work well for OCD. They are as follows:
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Clomipramine (Anafranil)
- Venlafaxine (Effexor)
These antidepressants have been studied and tested for their effectiveness against OCD. However, there are hundreds of case reports citing other drugs that help treatment-resistant OCD patients. These drugs must generally be administered in high doses to be effective.
A common mistake made by patients living with obsessive-compulsive disorder is taking doses of antidepressants during times of stress. Antidepressants need to be taken in consistent and prescribed doses every day and are not to be taken like an anxiety medication.
While many patients feel the effects of antidepressants in the first few days, for other patients it can take as long as 10 to 12 weeks before the drugs begin to work. Some people are able to stop their antidepressant regimen after 12 months while approximately 50 percent must maintain doses for years or even their entire lives.
How to Find the Best OCD Treatment Facility
Your psychiatrist may be able to advise you about how to find the best OCD treatment facility. You can also check with local mental health facilities for advice. Prioritize your mental health with an easy and effective mental health quiz. The easiest way to get information about treatment programs that meet your needs is to contact us at . We are here 24/7 to assist you.
