US Pharm. 2017;42(11):15-16.

Persistent, Uncontrollable Thoughts

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder whose name suggests its symptoms. People with OCD experience obsessions or persistent thoughts that are uncontrollable and not based in reality. They may also experience compulsions, repeated actions that help relieve the anxiety caused by the obsessive thoughts. OCD was once thought to be an uncommon problem, but it is now estimated to affect more than 2 million Americans. Researchers do not fully understand the cause of OCD, but it is most likely a result of a low level of a brain chemical called serotonin.

OCD Is an Anxiety Disorder

People with OCD are bothered by obsessive thoughts, such as a fear of germs or dirt, a deadly disease, an intruder entering the house at night, or harming someone. To control the anxiety that these thoughts cause, the person with OCD feels compelled to take repeated action in a ritual-like manner. These compulsions include excessive handwashing, visits to the doctor to rule out diseases, checking door and window locks over and over, and routines to prevent harming others, such as counting or touching things in a particular order.

People with OCD live a life ruled by their obsessions and compulsions, which can seriously interfere with school or work. Most people with OCD feel ashamed of their obsessive thoughts and compulsive behaviors. Since they are not able to control them, they cope by hiding them from friends and family to avoid embarrassment. Symptoms may worsen or improve over time, but in many cases, symptoms eventually interfere with a person’s ability to function and enjoy life. Although most people with OCD understand that these rituals are senseless, they feel driven to repeat them to rid themselves of their anxious thoughts.

Signs and Risk Factors

OCD often appears in childhood or teenage years, affecting males and females equally. In many cases, the early symptoms of OCD may not be troublesome or life-altering, but they may seem to be part of a “compulsive” or “overachiever” personality. OCD may present along with other anxiety disorders, eating disorders, or depression. In some cases, OCD runs in families, and the risk of OCD is higher in people with a family history of other psychiatric disorders. Being raised in an extremely rigid, controlled environment was once thought to be a predictor of OCD; this is likely not true, but major life stressors may trigger the symptoms. Pregnant women and new mothers may develop symptoms of OCD, with the obsessive thoughts centered on harming the child.

Psychotherapy and Antidepressants Treat Symptoms

Treatment of OCD includes cognitive behavioral therapy and medications. Exposure and response prevention is a specific type of psychotherapy used to help patients manage their OCD symptoms. Patients gradually expose themselves to their obsessions without allowing their ritual or compulsion to follow right away. Patients start to feel less and less anxious from the obsessive thoughts and can resist their compulsive behavior long after therapy has ended. 

Some people may also need medications to help them control their symptoms. Drugs commonly prescribed for OCD work by increasing the action of serotonin in the brain. A group of antidepressants that act in this manner have been approved by the FDA, including clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). After several weeks of daily medication, a majority of patients will notice significant relief of their symptoms. The main side effects of these antidepressants are drowsiness, headache, and nausea. They can interact with many other medications, so make sure your pharmacist and doctor are aware of all medicines taken with these antidepressants. Once the symptoms are controlled, the dose can be decreased and even discontinued in some patients.

Your local pharmacist is here to help! If you, a friend, or family member have questions about OCD and medications used in treatment, ask a trusted pharmacist.

To comment on this article, contact rdavidson@uspharmacist.com.