Cognitive behavioural therapy is usually recommended as the first choice in the treatment of OCD. However, in more severe cases of OCD, or where cognitive behavioural therapy has not been effective enough, it may be necessary to combine counselling with medication.
In the main, antidepressants are used and are effective in the treatment of OCD. This medicine was originally developed to treat depression. The most commonly used types are selective serotonin reuptake inhibitor (SSRI) drugs. The name is derived from the chemical effect of the substance. There are several different types of SSRI drugs, and if one drug is not sufficiently effective, or has unacceptable side-effects, there may be good reason to try a different drug. In addition to SSRI drugs, an older type of antidepressant, chlomipramine, is also used in the treatment of OCD. Sometimes, the addition of a small dose of anti-psychotic medicine can be effective when combined with an anti-depressant.
Unfortunately, it can take a long time for the medication to work. It requires patience to wait for the effect of the treatment, but it is important to try one drug thoroughly before possibly switching to a different one. It is also important to take a sufficiently high dose.
Medication rarely results in the OCD symptoms disappearing altogether, but many report that their compulsive thoughts become less intrusive, and the urge to engage in the compulsive behaviour is reduced.
Some, but by no means all, experience side-effects from the medicine. Many side-effects disappear after a few weeks of treatment, and the remaining side-effects are usually mild.
However, some people do experience persistent side-effects, and in these cases, switching to a different drug may be necessary. Any side-effects disappear when the person comes off the medication, and none of the SSRI drugs, antidepressants or anti-psychotic drugs lead to physical dependency.
If the medication is effective, it is advisable to continue with it for at least six to twelve months after there has been an improvement, after which the medication can be gradually tapered off under the supervision of the doctor. It is important to taper off the medication under the supervision of a doctor and over a period in which the person is doing well and is not exposed to external stresses.
Some people experience a relapse when tapering off the medication, and at that point it can be an advantage to be familiar with the cognitive behavioural therapy methods and tools so that these can be used if there are signs of a relapse. Some people may need life-long medication.