For those persons suffering from obsessive-compulsive disorder (OCD), there are effective ways to get help. In fact, research has shown two treatments for OCD to be quite effective in reducing symptoms: 1) Exposure and response prevention therapy (also known as ERP), and 2) psychotropic medication. Both options have their advantages and disadvantages.
Treatments for OCD: Medication
Doctors and nurse practitioners will commonly prescribe Fluvoxamine (Luvox), sertraline (Zoloft), and fluoxetine (Prozac) to treat OCD. These three medications all belong to the same class (SSRIs) of medications. They are often used because of their low rates of severe side effects — they are considered quite safe.
Clomipramine (Anafranil) has been sometimes been found to be more effective than SSRIs in treatment of OCD (see Greist et al., 1995) but is generally held to have a less desirable side effect profile. other studies produced different results. All told, Clomipramine and the SSRIs are generally believed to be similarly effective in treating the symptoms of OCD. Clomipramine is part of an older class of medications called tricyclic antidepressants. It also works by affecting the way that serotonin is reabsorbed by neurons in the brain, just like SSRIs.
Unfortunately, a disadvantage of using any such medication is that symptoms often return once the medication is discontinued. One study found that this sort of relapse happens in almost 90% of cases (Pato et al., 1988). Despite that, many people opt for medication because it’s easy to do, and often affordable with most insurance plans.
Exposure and Response Prevention
ERP therapy has the advantage of lower relapse rates following treatment. Research has found that between 63% and 90% of patients respond to this type of therapy (Wilhelm et al., 2004). We also know that relapse rates following ERP therapy are significantly lower than they are for SSRI treatment. Why would this be?
One likely reason is that ERP teaches patients skills they can practice and use to reduce their symptoms. They can continue to use these skills for years after therapy is complete; ideally, their use becomes automatic, and long-lasting change follows.
Comparing the two
Both medication and ERP therapy are effective and smart for treatments for OCD. However each of the two has pros and cons. The advantage of SSRI treatment is largely practical in nature. Taking a pill every morning is easy to do. If your insurance helps you obtain the medication, it’s often quite affordable as well.
The disadvantages would include the fact that SSRIs, like most medications, can have side effects. Typically these are mild, but they can include sexual side effects, headaches, insomnia and weight gain. For pregnant women, SSRIs are not ideal due to some documented risks of birth defects. Additionally, SSRI treatment for OCD involves prescribing doses that are higher than those used for depression, typically. This may have the effect of increasing risk of or severity of side effects. Despite that, SSRIs are commonly used for OCD and are usually well tolerated.
Exposure and response prevention
The advantages of doing exposure and response prevention include the following:
- It’s all natural
- Some studies suggest it’s more effective alone for OCD than medication alone
- Gains made are likely to last longer than those made with medication treatment.
The disadvantages would be these:
- It can be hard to find a local provider specializing in OCD, although in major cities this is untrue
- Insurance often provides less coverage for ERP than it does for medication
- It takes time out of your weekly schedule
- It can be hard work exposing yourself to unpleasant feelings.
Overall we are fortunate to have two good options for OCD treatment, neither of which existed before 50 years ago. Which one is right for you?
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