Cognitive behavioral therapy, exposure and response prevention, and antidepressants are the current standard treatments for OCD, or obsessive-compulsive disorder.
Unfortunately, these treatments of choice are effective for only a portion of OCD sufferers.
Though a percentage of treatment failure is attributed to lack of engagement by some patients, or the presence of debilitating psychotic or depressive symptoms in others, there is clearly a need for new OCD treatment options.
Fortunately, researchers are working to establish therapy alternatives for OCD, and their findings are providing relief for an increasing number of people. Here is a summary of current and emerging treatments.
Pharmacological Advances
SSRI antidepressants help many individuals manage OCD symptoms, but other drugs may give SSRIs a needed efficacy boost, or possibly replace them:
- Combining serotonin re-uptake inhibiting antidepressants (SSRIs) with clomipramine (a tricyclic antidepressant) may provide some OCD sufferers with short or long term relief. So might supplementing SSRIs with dopamine-blocking antipsychotic agents.
- Low doses of some second-generation antipsychotics (e.g., olanzapine, quetiapine, resperidone, and aripiprazole) may effectively augment an SSRI and CBT (cognitive behavioral therapy) based treatment plan.
- Glutamate-blocking drugs (e.g., memantine) may successfully boost SSRI treatment for OCD and is potentially a stand-alone therapy option. (Glutamate is a neurotransmitter that’s been associated with OCD).
- Other drugs being researched for improved OCD outcomes are ketamine, lamotrigine (an anti-convulsant), and n-acetyl-cysteine (modified version of the amino acid cysteine).
Psychotherapeutic Approaches
CBT remains an effective therapy for many disorders including OCD, but for some individuals it might be enhanced or replaced by several promising options:
- Using d-cycloserine (DCS) to supplement cognitive behavioral therapy is promising for OCD symptom relief. DCS seems to advance the extinction of fears by amplifying the learning and memory processes behind it. It apparently does this by stimulating certain neurotransmitter receptors in the brain’s amygdala.
- An inference-based approach to OCD treatment may help sufferers with limited insight into the disorder. This approach teaches people to rely on in-the-moment sensory data to assess reality, instead of putting faith in obsessive reasoning.
- Cognitive remediation therapy is potentially useful for OCD as it cultivates flexible learning and thinking skills. It utilizes exercises that enhance, for instance, memory, planning, and decision-making functions.
- Habit reversal therapy heightens an OCD patient’s awareness of urges that precede compulsive behaviors, so they can choose symptom challenging responses instead. The goal is to replace low-energy compulsive habits with purposeful, productive activity.
Invasive Alternatives
Where other treatments fail to help OCD sufferers, invasive surgery may succeed:
- Research indicates ablative surgery - the removal or destruction of specific brain tissues - may provide a 30 to 60 percent symptom improvement in treatment-resistant OCD patients.
- Deep brain stimulation is a less invasive approach. It works by overriding and altering abnormal hyperactivity in affected brain networks using implanted electrodes. This treatment method has a reported 50 percent response rate, but it’s still unclear which OCD patient characteristics make this the best option.
Clinician Issues
OCD treatment outcomes may improve when noted clinician deficits are adequately addressed:
- An increased understanding of OCD treatment among clinicians may improve overall treatment results. Some clinicians, for instance, may not realize the most effective way to utilize drug therapy in OCD cases.
- Patients may not have access to CBT therapists adequately trained in OCD treatment protocols. Ensuring more therapists are knowledgeable about helping OCD clients assures treatments currently available will be optimally applied.
Sources: Psychiatry Advisor; Psychology and Behavior; Cognitive Remediation
Photo credit: Rachel Johnson
