A Shallow Dive into OCD Identification and Treatment

Obsessive Compulsive Disorder (OCD) is a chronic condition affecting approximately two percent of the global population. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). OCD is often a long-lasting disorder in which a person has uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) that he/she feels the urge to perform repeatedly.

The Prevalence of OCD

The prevalence of OCD worldwide is known through international studies providing intrinsic information-gathering through extensive research. In the United States of America, approximately one percent of the population has been diagnosed with OCD. Interestingly, demographics of OCD in the USA show no real ties to age, gender, race, or socioeconomic factors.

However, there seems to be a correlation between OCD and age, indicating an onset of OCD in younger people. The prevalence of OCD among the general population in the USA is seen early in life, with studies by the National Comorbidity Survey Replication (NCS-R); almost 25% of males presented with OCD symptoms before the age of ten.

The onset of OCD in females, in the same study, occurs during adolescence. Individuals aged 18-29 show the highest number of onset diagnoses. Interestingly, according to OCD Statistics-FHE Health, less than two percent of those diagnosed with OCD and other mental health issues come from lower-income homes.

OCD Diagnosis

OCD diagnosis includes three phases:

• Psychological evaluation
• Meeting the diagnostic criteria
• Physical exam

Psychological evaluation includes an honest discussion about thoughts, feelings, symptoms, and behavior patterns, and their possible interference with the quality of life. Diagnostic criteria identified by a physician, psychiatrist, or psychologist as set forth by the DSM-5. To rule out other psychological or even physical disorders (comorbid), a physical exam may be administered.

Once a person has been correctly diagnosed with OCD and/or with accompanying disability (comorbidity), the individual can then be prescribed a medicine from a variety of treatment regimens to keep symptoms at a minimum and possibly lead to remission. The individual and his/her physician will consider medication(s), possible side effects, interactions with other medications, and the possibility of suicidal ideation.

Non-medical Treatment Avenues

Effective treatment of OCD includes Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention. With care and attention by the individual’s mental health professional, psychotherapy shows promising outcomes and reduction of symptomology, gradually exposing the individual to feared object(s) and/or obsession(s), then learning ways to resist urges to follow through with the rituals that characterize the person’s disorder.

Once a client has been correctly diagnosed with OCD and/or with accompanying disability (comorbidity), the client can then be prescribed various treatment regimens to keep symptoms at a minimum and possibly lead to remission. The client and his/her doctor will consider medication, possible side effects, interactions with other medicines, and the possibility of suicidal ideation.

Effective treatment of OCD includes Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention. With care and attention from the client’s mental health professional, psychotherapy shows promising outcomes and reduction of symptomology. Gradually exposing the client to feared object(s) and/or obsession(s); then learning ways to resist urges to follow through with the rituals that characterize the client’s disorder.

Treating OCD with Medication

Psychotherapy with medication proves to be more effective in combating OCD than either treatment alone. Psychiatric medications used to treat OCD include Clomipramine (Anafranil), Fluoxetine (Prozac), Fluvoxamine (Luvox), Paroxetine (Paxil), and Sertraline (Zoloft).

These medicines alone may provide the right amount of chemical therapy, and other medications may be prescribed as a secondary agent to work alongside the primary drug, to help in the overall treatment.

Anafranil (Clomipramine Hcl), is classified as an antidepressant and TCA (Tricyclic Antidepressant) and was approved by the Food and Drug Administration (FDA) for treating OCD only, and that from the age of ten and older.

Clomipramine is administered orally; however, it is also available as an intravenous treatment. The maximum treatment dosage is 250 mg, and efficacy is usually noticed in six to twelve weeks; since Clomipramine is a sedative, it helps in treating insomnia.

Adverse effects include nausea, weight gain, increased appetite, sedation, dry mouth, constipation, urinary retention, blurred vision, headache, dizziness, fatigue, hypotension, anxiety, restlessness, sweating, discolored urine, and sexual dysfunction.

Other disabilities treated by Clomipramine include depression, anxiety, treatment-resistant depression, Cataplexy Syndrome, insomnia, neuropathic pain, chronic pain, body dysmorphic disorder, and panic disorder, among others.

Prozac is also known by its generic form, Fluoxetine, is classified as a Selective Serotonin Reuptake Inhibitor antidepressant (SSRI) and is indicated for the treatment of OCD, and is also prescribed for other mental disorders, e.g., panic disorders, and bulimia nervosa.

Prozac is used in children as young as three years of age through adulthood. The maximum effective dose of Prozac in adults is 80mg. Prozac is administered as an oral solid or liquid. Side effects include visual impairment, tardive dyskinesia, suicidal ideation, and heart failure.

Abrupt discontinuation of Prozac can result in various symptoms, such as seizure disorder, growth inhibition, and suicidal ideation, to name a few. The cost of Prozac can deter patients from paying out-of-pocket; however, after consultation with the prescribing doctor and communication with the pharmaceutical companies, qualified individuals may receive a discounted price.

Prescription Assistance Programs exist to help offset the price, including, but not limited to, government prescription assistance programs, nonprofit prescription assistance programs, and other nonprofit prescription assistance programs.

Off-label uses of Prozac may include Generalized Anxiety Disorder (GAD), migraine headaches, and diabetic neuropathy. The numbers reinforce the beneficial use of Prozac in treatment since its release in the market in 1985.

Another effective drug considered is Luvox, also known as Fluvoxamine Maleate. It is classified as an antidepressant and is indicated for the treatment of OCD along with depression. Treatment levels of Luvox begin at 25 mg to a maximum of 200 mg/day for children, and a maximum dosage amount for adults at 300mg/day.

Side effects include nausea, somnolence, insomnia, asthenia, nervousness, dyspepsia, sweating, and anorexia. Off-label treatment of social phobia(s), panic disorder, and post-traumatic stress disorder (PTSD) has proven successful.

Paxil is a popular antidepressant that has been on the market for more than a decade, also known by its generic name, Paroxetine, and was significantly more effective than a placebo in clinical trials, and was shown to have a therapeutic response for one year. It is well-tolerated and confidently used in the treatment of OCD. Studies also show that Paxil has an earlier onset of efficacy than that of Fluoxetine (Prozac) and even that of placebos.

Adverse reactions to Paxil include headache, somnolence, dry mouth, insomnia, and sweating. Discontinuation of Paxil should be done incrementally, as sudden withdrawal is known to be uncomfortable. Typically, Paxil is prescribed initially at 20 mg/day to an effective dosage of 60 mg/day.

Off-label uses for Paxil include OCD, social anxiety disorder in children and adolescents, social disorder, separation anxiety, dysthymia, and body dysmorphic disorder. Contraindications of Paxil include (by simultaneous use of thioridazine) cardiac arrhythmias.

Zoloft, also known by its generic name, Sertraline, is also classified as an SSRI, antidepressant, and is indicated for the treatment of OCD as well as other psychiatric disorders like depression, PTSD, panic attacks, and anxiety disorder. Off-label uses of Zoloft include autism, alcoholism, dementia, eating disorders, migraines, and Tourette’s syndrome. Side effects include nausea, headache, diarrhea, restlessness, dry mouth, fever, and dizziness.

Beginning treatment dosage of Zoloft is 25 mg/day, up to a maximum effective dosage of 200 mg/day. As with other prescription drugs, for the treatment of obsessive-compulsive disorder, prices that take into consideration costs such as research and profit hover over the $140 per thirty tablets. Zoloft efficacy shows a rate of 50% reduction of OCD symptoms in both children and adults.

OCD, like several disorders, is often lumped into a pile of mental struggles – added stigma and a means of “suffering in silence” can be successfully treated and managed by a therapeutic action plan that includes an effective medication regimen, consistent and effective counseling sessions.

Next Steps

If you suspect you may have OCD, or have already been diagnosed, please contact us. We would be honored to help you navigate treatment options and get you on the road to wellness.