Many people with OCD also suffer from depression. Dealing with both can be very challenging. Learning how to manage these conditions is important.
Obsessive-Compulsive Disorder (OCD)
There are a lot of misconceptions about what OCD is. OCD is not simply a term for a preference that things be organized or clean. It is a potentially serious disorder that can become disabling for some people.
What does OCD look like? It varies widely from one type of OCD to another, but it always involves obsessions, compulsions, or (typically) both.
What are obsessions?
Obsessions are feelings, thoughts, or images that are unwanted and intrusive and produce immediate anxiety or discomfort. They tend to repeat quite often despite efforts to “get rid of” them.
Common obsessions include:
- The thought or feeling that one is contaminated
- A thought or image of doing something violent or shocking, like attacking a stranger
- Doubts about having left a door unlocked or a stove burner on
- Thoughts or images about sexual acts one does not want to commit
What are compulsions?
Compulsions are mental or observable physical actions. They are an effort to limit the anxiety or discomfort produced by an obsession.
Common compulsions include:
- checking locks, stoves, or appliances
- counting things
- cleaning things
- repeating movements or phrases
- hand washing
- reassurance seeking
(See also our OCD overview page for more information.)
Major Depressive Disorder
Major depressive disorder is a type of depression that significantly impacts one’s life for at least two weeks. Episodes of major depressive disorder can last for years. Symptoms can include:
- low self-worth
- pervasive sadness
- reduced interest in enjoyable activities
- difficulty concentrating
- changes in appetite or weight
- reduced energy levels
- thoughts of death or suicide
- excessive inappropriate guilt
- changes in sleep quality and amount
(See also our depression overview page for more information.)
The Challenges of Having Both OCD and Depression
Either of these two conditions can significantly impact your life. Having both presents difficulties that either condition alone would not.
For example, people with OCD often see significant improvement from doing a form of cognitive-behavioral therapy called exposure and response prevention (ERP/ExRP). This therapy is quite effective, but it requires work from the patient. If the patient is depressed, it may be difficult for him or her to complete all the exercises recommended by the ERP/ExRP therapist. This will significantly slow any improvement.
Another example would be someone in therapy for depression who is looking to become more active and engaged. Making changes like these is often helpful for those with depression. Unfortunately, compulsions can make it difficult or impossible to engage in new and enjoyable activities. How does this work? It can be difficult to leave the house if you need to check the stove dozens of times before you go. Meeting new people is daunting if you’re depressed, and it’s even harder if you have obsessive thoughts that can interfere, e.g., getting herpes from shaking hands with a new acquaintance.
Treatment for OCD and Depression
Fortunately, there are effective treatments for the combination of depression and OCD.
Therapy for depression
Various forms of psychotherapy have been proven to be effective in treating depression. The American Psychological Association recommends the following therapies:
- Behavioral therapy
- Cognitive therapy
- Cognitive-behavioral therapy (CBT)
- Mindfulness-based cognitive therapy (MBCT)
- Interpersonal psychotherapy (IPT)
- Psychodynamic therapies
- Supportive therapies
Therapy for OCD
In contrast, the psychotherapies recommended for OCD are much more limited. Exposure and response prevention (ERP), mentioned above, is the therapy of choice for OCD. Since ERP does not help with depression, and the therapies that help for depression typically do not help for OCD, people with both conditions should seek out a therapist skilled in therapy for both conditions. Fortunately, many therapists trained in ERP are also proficient in cognitive-behavioral therapy as well.
Medication for OCD and depression
The use of medication — also called pharmacotherapy — can also be effective for OCD and depression. Psychiatrists often prescribe selective serotonin reuptake inhibitors (like Prozac, Luvox, Lexapro, or Zoloft) to treat these problems. Other medications can be added if the first one is insufficient.
The combination of OCD and depression can be difficult to deal with. If you’re interested and would like to discuss starting therapy for OCD, depression, or both, please contact us to discuss your options.