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Medication

The treatment found to be the most effective in successfully tackling OCD is a special form of talking therapy called Cognitive Behavioural Therapy (CBT), which remains the treatment of choice for all forms of OCD.

In many cases, CBT alone is highly effective in treating OCD, but for some people a combination of CBT and medication is also effective. This usually takes the form of antidepressants which act in the Serotonin System called SSRIs (Selective Serotonin Re-uptake Inhibitor). The best known and most widely used of these is Fluoxetine (Prozac).  Medication may reduce the anxiety enough for a person to start, and eventually succeed in therapy.

Many experts believe that CBT tends to be a faster acting, longer lasting, and more cost effective treatment over time than medication, and does not involve the risk of side effects. Research also seems to show lower rates of relapse when CBT is discontinued, compared to that of medication, where relapse is more common.

We do not know exactly why SSRI’s can sometimes be helpful for people with OCD, but they sometimes work by reducing the severity of the obsessive-compulsive symptoms, by ‘taking the edge off’ some of the anxiety experienced as a result of the illness.

SSRIs (selective serotonin reuptake inhibitors) are usually tried first (before non-selective SRIs) because SSRIs only act on serotonin. The SSRIs usually recommended for the treatment of OCD in the UK are:
Medication Type: Selective Serotonin Reuptake Inhibitors (SSRI)

At the time of writing, the NICE guidelines for the treatment of OCD only recommend two of these medications for use in treating children with OCD. These are Sertraline for children aged 6 years and older and Fluvoxamine for children aged 8 years and older.

Drugs often have several names. When a drug is first discovered, it is given a chemical name, which describes the atomic or molecular structure of the drug. The chemical name is thus usually too complex and cumbersome for general use, so it is given a generic (official) name and a trade (proprietary or brand) name. The trade name is developed by the company requesting approval for the drug and identifies it as the exclusive property of that company. For example, the generic name for Prozac is Fluoxetine.

This is not an exhaustive list, and sufferers may often be prescribed additional medications to enhance or augment the effects of these SSRIs.

Typically, the process of determining the most suited medication for an individual is achieved on a trial-and-error basis. However, in order to allow its maximum effects to be adequately observed, each medication should be taken for a specified time period, usually for at least 12-16 weeks, before seeking out an alternative.

If these medications fail to work, a non-selective SRI may be prescribed. However, because it affects neurotransmitters in the brain, other than just serotonin, there are more side effects and therefore it is usually not a first choice medication for treating OCD. The non-selective SRI most commonly used for treating OCD is:
Medication Type: Tricyclic Antidepressant (TCA)

The NICE guidelines state Clomipramine should be considered in the treatment of adults with OCD or BDD after an adequate trial of at least one SSRI has been ineffective or poorly tolerated, or if the patient prefers Clomipramine or  has had success in using the medication before.

In many cases, CBT alone is highly effective in treating OCD, but for some people a combination of CBT and medication is more effective.

Jeffrey Schwartz M.D., Neuropsychiatrist at the UCLA School of Medicine, applies a metaphor of the administering of drug treatment in his book Brain Lock. He defines their principal purpose as similar to that served by ‘water wings’ (armbands) in the initial stages of learning to swim. They offer a means of keeping the sufferer ‘afloat’ while he or she is developing and consolidating the new psychological skills necessary to combat OCD longer-term. Thus, they are incredibly useful at the outset of treatment as a means of ameliorating the effects of psychotherapeutic intervention strategies such as CBT.

Although you may stop taking SSRIs whenever you wish, it is sensible to reduce them gradually under supervision from your GP, or ideally your Psychiatrist.  NICE recommend that if the medication has helped you, you should continue taking the medication for at least 12 months to ensure your symptoms continue to improve.

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