Frustration, sadness, and despair. Feeling like you’re trapped in a cycle. Everyday tasks seeming like insurmountable obstacles. While anyone who’s struggled with OCD is probably all too familiar with these experiences, they also happen to be common characteristics of depression. Considering this, it might not surprise you to learn that OCD and depression can occur at the same time—and that it happens frequently. According to the International OCD Foundation, around 25% to 50% of people with OCD also meet the diagnostic criteria for a major depressive episode.
Depression can amplify the challenges of managing OCD, resulting in a significant impact on your mental, emotional, and physical well-being. It’s important to recognize this impact, and equally important to recognize that there is hope. Understanding the relationship between OCD and depression paves the way for you to more effectively navigate them both. Learn more about how these conditions can be linked, and 5 steps you can take to manage their symptoms.
OCD’s relationship to depression
When people are struggling with both OCD and depression, the question that often comes to mind is, “What came first, the chicken or the egg?” Or in this case, “Which came first, the depression or the OCD?” The truth is that we don’t fully know. While both disorders are distinct and complex, they seem to interplay with one another—which makes sense, given that if you’re anxious or having intrusive thoughts, you may start to feel hopeless, extremely tired, or overwhelmed. Additionally, if you’re feeling down and depressed, you may start to have more negative thoughts.
What I always say is that it really doesn’t matter where these conditions stemmed from or why the symptoms are there, at least not in terms of treatment. It’s not that origin isn’t important, because it’s understandable to wonder about that. It’s that treating OCD and depression so that you can live your best life now is the highest priority. Without the appropriate care, many people who suffer from OCD and depression will see an increase and worsening of their symptoms.
Symptoms of depression will vary for each person, but we often think of depression as a persistent low mood or sadness, loss of interest or pleasure, decreased energy, and incessant negative thoughts including suicidal ideation. Difficulty concentrating, sleep disturbances, and changes in appetite are a few of its many other possible symptoms. Feeling depressed can cause you to withdraw from activities that used to bring you joy or fulfillment, which only perpetuates the low mood you’re experiencing—creating a cycle not all that different from the cycle of OCD.
Steps you can take to manage depression and OCD
The good news about OCD and depression is that taking steps to manage one of these conditions will often positively impact them both. Incorporating techniques based on improving your well-being into your daily life can help you learn to manage the intrusive thoughts, anxiety, and low moods associated with OCD and depression.
1. Seek professional help
This might seem obvious, but it’s important enough to bear repeating. In the same way that you would see a medical doctor for an injury or physical ailment, seeking the help of a specialist in OCD is highly recommended if you’re struggling with OCD and symptoms of depression. Because OCD can be so misunderstood and nuanced, not every mental health specialist will have the specific training that’s necessary to effectively treat it. It will be important to find a professional who can treat both OCD and depression, as this expertise will enable your provider to decipher which disorder needs to be focused on more heavily in the beginning.
Sometimes, if the depression is more prominent, it will need to be more controlled before your treatment plan moves to treating the OCD. If the OCD is more dominant, on the other hand, then this can be addressed earlier on, which will likely impact the depression symptoms positively. Thankfully, many professionals have training and practice in treating depression, so looking for an OCD specialist first can help guide your search to find a provider with knowledge of both conditions.
2. Make self-care a priority
This doesn’t mean the warm bubble baths, facial treatments, and spa days that we often see portrayed as self-care. There’s a time and a place for those activities, but the self-care we’re talking about here is something much deeper and more profound. It’s a kind of self-care that, with patience and effort, delivers lasting results. The self-care you’ll benefit the most from prioritizing is self-compassion: the practice of being kind to yourself, prioritizing your mental health-related needs, and taking good care of yourself in a way that fills your bucket, so to speak.
In order to practice this kind of self-care, it can help to begin with reflection. What keeps you moving towards your values and goals in life? What steps are you taking to live the life that you truly want to be living? Remember that self-care in its most basic form is the act of treating yourself kindly. If someone you love came to you and said that they were struggling, would you judge them for it? Respond to yourself in the way you’d respond to someone whom you love and care for deeply. Give yourself the same kind of love and forgiveness that you’re so willing to give to others who are suffering. You’re worthy of that same compassion and you always will be.
3. Practice mindfulness and staying present
I once heard that depression is when you get caught up living in the past and anxiety is when you are trying to live in and predict the future. I love this, because it reminds me of the importance of being present right now, in this very moment. When we’re living in the past or trying to control the future, we’re missing the here and now. Struggling with OCD and depression can feel like playing tug-of-war with your mind, constantly trying to pull your attention away, only to have it get caught up in your thoughts once again. Learning ways to practice mindfulness and bring ourselves back to the present moment can help us change this pattern.
Staying present starts with focusing on the moment in front of you and engaging your senses. Observe where you are. Take a deep breath. Look around you—what do you see? Listen closely—what do you hear? Engage your taste—it can help to have a piece of candy or gum on hand for this very purpose. Use your senses to become more aware of the moment you’re in, however it presents itself to you. Grounding techniques like these can help alleviate the emotions caused by OCD and depression, providing you with some separation from intense feelings without avoiding them.
Depressive symptoms can make it hard to think about the future, or to feel anything at all at times. In those moments, grounding techniques can help you to feel something, bring you back to the present, and focus your attention. When treating depression, it may be helpful to also address negative experiences or thought processes that feed the depression. With both depression and OCD, you may have to practice choosing not to follow those endless rabbit holes of what-ifs.
4. Be conscious of how physical and mental health are connected
We might all know this to be true on some level, but knowing and doing are completely different things. When we take care of our mental health, we are taking care of our physical health—and vice versa. What you eat, what you drink, what you put in your body, it all matters.
Exercise can have a huge impact on one’s mood and overall sense of well-being in any situation, but especially when you’re dealing with OCD and depression. The catch here is that when you’re feeling depressed, even getting out of bed can seem like an enormous ordeal, let alone going out and exercising. This is where Behavioral Activation (BA), the primary treatment for depression, can play an important role. In its basic form, BA is about making a choice to act in a specific way, even when—especially when—you don’t feel like it.
Depression can work similarly to OCD, in the sense that both conditions may operate in a cycle. Depression can make people withdraw from the activities they enjoy, which often exacerbates their symptoms. The more someone is able to choose to participate in these activities—to get out of bed, get dressed, and go for a walk, as challenging as it may seem in the moment—the better they will feel. This is not all that different from the OCD sufferer who, over time, will achieve a decrease in anxiety and distress by practicing doing the opposite of what OCD is telling them. Because of this, practicing physical actions that benefit your mental health is a coping technique that can have positive results for both conditions.
5. Learn when to challenge a negative thought and when to not engage
When you suffer from OCD, the goal isn’t necessarily to “challenge” intrusive thoughts. Rather, the goal is to accept them as just being thoughts and not judging them, giving them meaning, or assuming they indicate true intent or danger. When you have OCD, the thoughts that torment you are often ego-dystonic. Simply explained, this means that they go against your values, your true desires, and your character—which is why they can feel incredibly distressing and meaningful.
If you’re struggling with a combination of depression and OCD, you may have observed that depressed thoughts can sound a lot like the intrusive thoughts of OCD. You may also have intrusive thoughts that are unrelated to OCD. Some common thoughts that people with depression struggle with are thoughts of being worthless, or excessive guilt over things they may have said or done in the past. What makes depressive intrusive thoughts unique from those of OCD is that they can benefit from cognitive behavioral therapy (CBT), particularly when it’s used to challenge their validity.
Like any element of treating depression and OCD, this is best navigated with the help of a professional, who will have the expertise to teach you when a thought is stemming from OCD and when it’s related to depression. A qualified therapist can assist you in knowing when to challenge thoughts and when to simply notice them. In addition to seeking professional support when possible, it’s important to have a healthy support system in place, to give yourself compassion, and to take care of your needs. With time, both of these conditions can be managed. It’s possible for you to live a fulfilling life driven by your values, and there is support and resources to help you get there.
Struggling with OCD and depression doesn’t have to be forever
For anyone feeling weighed down by untreated OCD and depression, it’s vital to know that you don’t have to struggle forever. Both OCD and depression are treatable, and the most effective treatments for both conditions work incredibly well together. The key often lies in determining which one is causing the most difficulty with functioning and treating it first. There are many situations when depression and OCD can be treated simultaneously, but there are also instances when depression is primary and may need to be successfully addressed before exposure and response prevention (ERP) therapy, the gold-standard treatment for OCD, can be successful.
In cases where depression interferes with a person’s ability to participate in exposure and response prevention (ERP) therapy for OCD, BA, can help them overcome this obstacle. Once symptoms of depression are better controlled, an individual is more likely to participate effectively in ERP, allowing them to experience its life-changing benefits. Because ERP and BA are so similar (both treatments help people better understand their current behaviors and teach them how to practice more rewarding ones, helping them feel better over time), pairing them is an effective hybrid approach to tackling both depression and OCD.
At NOCD, you can get both of these evidence-based treatments within our network. NOCD Therapists are trained in both ERP and BA to help you conquer OCD and depression. They’ll use their expertise to design a treatment plan for your unique needs and symptoms and provide non-judgmental support every step of the way. To prevent cost from being a barrier to accessing life-changing treatment, NOCD partners with many insurance plans and offers affordable options for our members not using insurance, including interest-free payment plans. You can book a free 15-minute call with our team to learn more.