Human and animal research sponsored by many scientific organizations has provided information leading to both pharmacologic and behaviourial treatments that can benefit the person with OCD. A combination of the two therapies is often an effective method of treatment for most patients. Some individuals respond best to one therapy, some to another.
Pharmacotherapy
Clinical trials in recent years have shown that drugs that affect the brain-chemical serotonin can significantly decrease the symptoms of OCD. Serotonin reuptake inhibitors (SRIs), clomipramine (Anafranil), generic fluoxetine and Prozac, and fluvoxamine (Luvox) have been approved in Canada for the treatment of OCD. Other SRIs that have been studied include sertraline (Zoloft) and Paroxetine (Paxil). Sertraline (Zoloft) is currently being studied by researchers in many centers in Canada, including at the Queen Elizabeth II Health Science Center in Halifax. All these SRIs have proven effective in the treatment of OCD. If a patient does not respond well to one SRI, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of great help in controlling the symptoms of OCD, particularly the obsessional thoughts. However, if the medication is discontinued, relapse will often follow. Most patients can benefit from a combination of medication and behaviourial therapy, this combination being better than any one treatment alone. In young children treated at the IWK-Grace Hospital in Halifax, medications alone have been shown to be helpful in situations where the child or family is unable to take part in behaviour therapy.
All medications have side-effects, so they must only be taken as prescribed by a physician. Fortunately, the newer medications, like fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft) and Paroxetine (Praxil), are relatively safer and have fewer side-effects than the older medication, clomipramine (Anafranil).
Behaviour Therapy Traditional psychotherapy, aimed at exploring early parent-child relationship and helping the patient develop insight into his or her problem, is generally not helpful in OCD. However, a specific behaviour therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient is deliberately and voluntarily exposed to the feared object or idea, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand-washer may be urged to touch and object believed to be contaminated, and then may be denied the opportunity to wash for several hours. Although there may be much fear and anxiety in the early stages, when the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts and us able to resist compulsive actions for long periods of time.
Studies of behaviour therapy for OCD have found it to produce long-lasting benefits particularly where there are clear rituals or compulsions. To achieve the best results, a combination of factors is necessary: the therapist should be well trained in behaviour therapy; the patient must be highly motivated (and this is often hard with young children); and the patient's family must be cooperative, motivated, consistent and have plenty of energy. In addition to visits to the therapist, the patient must be faithful in fulfilling "homework assignments." For those patients who complete the course of treatment, the improvements can be significant. Behaviour therapy is relatively less effective where a sufferer has serious obsessions with few or no compulsions. Specialized treatment to deal with obsessional worries and fears, called Cognitive-Behaviour Therapy (CBT) is not proven to be as effective as SRI medications.
With a combination of Pharmacotherapy and behavioral therapy, the majority of OCD patients will be able to function well at school or work, and socially. The ongoing search for causes, together with research on treatment, promises to yield even more hope for people with OCD and their families.