The earlier you seek treatment for obsessive-compulsive disorder (OCD), the better. Early treatment of OCD can reduce symptoms and reduce the disruption the illness can create in your life. Unfortunately, research shows that most people see an average of 3 to 4 health professionals and spend more than 9 years seeking treatment for OCD before they are correctly diagnosed.⁶ Their diagnoses are complicated by their being embarrassed or secretive about their symptoms and by other conditions they may have along with OCD, such as depression.

Treatment includes a combination of professional counseling and medicines.

Initial treatment

Depending on the severity of your symptoms, your doctor may prescribe only counseling or counseling and an antidepressant, such as fluoxetine (for example, Prozac), fluvoxamine (Luvox), or sertraline (Zoloft). For severely ill people who cannot function in a job or in social situations because of their symptoms, it is recommended that medicines be tried first before counseling.⁶

Should I take medicines to treat my OCD?

• Counseling:

A type of cognitive-behavioral therapy called exposure and response prevention is considered the most effective type of counseling for OCD.⁶ With exposure and response prevention therapy, you repeatedly expose yourself to an obsession, such as something you fear is contaminated, and deny yourself the ritual compulsive act, which in this case would be washing your hands. This therapy is done with a therapist or on your own with direction from your therapist.

In the beginning of exposure and response prevention therapy, your therapist may ask you to write a list of your obsessions, rituals (compulsions), and things that you avoid and then have you rank the amount of anxiety each of the obsessions causes from highest to lowest. You might begin exposing yourself to an obsession that causes a moderate amount of anxiety and then work your way up the list to the obsession that causes the most anxiety.

Therapists often combine exposure and response prevention therapy with cognitive-behavioral therapy to help overcome the faulty beliefs (such as fear of contamination) that lead to OCD behaviors.

• Medicines

Your doctor may first prescribe an antidepressant called a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (for example, Prozac), or a tricyclic antidepressant, such as clomipramine. You may start to feel better within 1 to 3 weeks of taking an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor. Your doctor may increase the dosage of your medicine or change to another SSRI if the first medicine prescribed doesn't help.

Ongoing treatment

Ongoing treatment for OCD includes monitoring the dosage and effectiveness of your medicines. Your doctor may want you to stay on one medicine for at least 10 to 12 weeks before trying a different antidepressant. Although antidepressants are considered the most effective medicine for OCD, researchers are studying whether other medicines, such as dopamine antagonists, can be combined with antidepressants for better results.