Can OCD be treated without medication?

Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects millions of people worldwide. It’s characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) that interfere with daily life. While a provider may prescribe medication to reduce OCD symptoms in some people, no drug addresses its root cause, and OCD is not often successfully treated with medication alone. 

The most effective way of breaking the OCD cycle, as we’ll discover in a moment, doesn’t involve taking any medication. Therefore, the short answer to the question posed at the top of this page could be a simple and resounding “Yes!”

However, that short answer obscures the fact that medication can help certain people with more severe OCD symptoms engage in exposure and response prevention (ERP) therapy—the gold-standard treatment for OCD—and begin to regain control of their lives, often in a matter of weeks. 

In this article, we’ll look at pharmaceuticals’ use in OCD symptom management, their limitations when used in isolation, and their supporting role in the long-term management of the condition. 

OCD explained 

As we touched upon at the very beginning, people with OCD have persistent, unwanted thoughts (obsessions) and enact repetitive behaviors (compulsions) that can damage their relationships, interfere with their school or work, and prevent them from living life to the fullest. We also mentioned something called the OCD cycle. Let’s take just a moment to explain what that cycle looks like.  

The OCD cycle 

The cycle starts with an intrusive thought. While everyone experiences intrusive thoughts, people with OCD ascribe meaning to them and develop obsessions around them. These obsessions can center on various things and are typically categorized into different subtypes, including checking OCD, counting OCD, relationship OCD, and harm OCD. 

For instance, if someone with OCD has a thought about hurting a child, they may question what this thought says about them, even though we are not our thoughts, and our thoughts do not define who we are.

This inability to separate themselves from their thoughts can cause extreme anxiety, leading people with OCD to engage in compulsions in an attempt to reduce their discomfort. These compulsions can range from reassurance-seeking to avoiding triggering situations or physical behaviors, such as excessive hand-washing in the case of contamination OCD. While compulsions can temporarily relieve anxiety, they reinforce the cycle of obsessions and compulsions, perpetuating the disorder.

The gold standard OCD treatment—ERP 

Exposure and Response Prevention (ERP) is the gold standard treatment for Obsessive-Compulsive Disorder (OCD) and has been shown to be highly effective in teaching people to manage OCD symptoms long-term and break the OCD cycle.

ERP works by helping people with OCD confront their fears and gradually desensitize themselves to anxiety-provoking situations or objects that trigger their compulsions. By preventing them from performing their compulsive behaviors, ERP breaks the cycle of anxiety and compulsions that characterizes OCD.

ERP is extremely effective at treating OCD in children, adolescents, and adults struggling with any theme or subtype of OCD. While everyone responds to therapy differently, most see a decrease in OCD symptoms within anywhere from eight to 16 weeks; some even find their symptoms nearly disappear altogether. 

It’s important to note that ERP can be challenging, and requires intention and commitment. Working with a specialist will allow you to determine the treatment plan that works best for you, whether it includes ERP alone or is supplemented by medication.

Which medications treat OCD symptoms, and how do they work? 

There are several types of medications used to treat Obsessive-Compulsive Disorder (OCD), including Selective Serotonin Reuptake Inhibitors (SSRIs)—the most common first-line medication used in OCD treatment—Tricyclic Antidepressants (TCAs), and atypical antipsychotics.

SSRIs are the most commonly prescribed medications for OCD. They work by increasing the levels of serotonin, a neurotransmitter that regulates mood, in the brain. 

TCAs are another type of antidepressant medication that may be used to treat OCD. They work by blocking the reuptake of both serotonin and norepinephrine.

Atypical antipsychotics are sometimes used with SSRIs or TCAs for people with severe OCD symptoms. They work by blocking dopamine.

Medications alone are not a silver bullet for OCD

While pharmaceuticals can help manage symptoms of Obsessive-Compulsive Disorder (OCD), they have several limitations when used alone. 

Firstly, and as we noted above, medication only targets the symptoms of OCD and does not address the underlying psychological factors that contribute to the disorder. Therefore, medication alone may not provide long-term relief from OCD symptoms, and medications are typically best used in combination with exposure and response prevention (ERP) therapy.

Secondly, medication can have side effects, which may be intolerable for some people. For example, SSRIs, the most commonly prescribed medication for OCD, can cause nausea, insomnia, and sexual dysfunction, among other side effects. Some people may also experience withdrawal symptoms when discontinuing the drug.

Thirdly, medication may not work for everyone. People with severe OCD symptoms may require higher doses of medication or a combination of drugs. Additionally, some people may not respond to medication at all, or their symptoms may return when they stop taking the drug.

How medications can help some people with OCD undergo ERP 

Medications can help enable a subset of people with OCD to withstand the challenges of ERP therapy in several ways:

1. Reduced anxiety: Many people with OCD experience high anxiety levels, making it difficult to engage in ERP therapy. Medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) and benzodiazepines can help reduce anxiety and make it easier to tolerate exposure to feared situations or objects, a critical component of ERP therapy.
2. Increased ability to resist compulsions: One of the goals of ERP therapy is to help people learn to resist their compulsions or rituals. Medications such as SSRIs and atypical antipsychotics can help reduce the frequency and intensity of obsessions and compulsions, making it easier for people to resist engaging in them during therapy.
3. Enhanced cognitive flexibility: People with OCD often have rigid thinking patterns and may struggle to think flexibly or adapt to changing situations. Medications such as SSRIs have been shown to improve cognitive flexibility, making it easier for people to learn and apply new coping strategies during ERP therapy.
4. Improved mood: OCD can be a highly distressing and debilitating condition, and people with OCD may struggle with depression or other mood disorders. Medications such as SSRIs can help improve mood and reduce the overall burden of symptoms, making it easier for people to engage in ERP therapy and other aspects of treatment.

It is important to remember that medication is not a substitute for therapy and should be used in conjunction with ERP therapy for optimal management of OCD. Any decision to pursue medication for OCD treatment should be made in consultation with a qualified healthcare professional, who can help assess a person’s needs and determine the most appropriate treatment plan.

Getting help

NOCD Therapy provides accessible, evidence-based ERP therapy through live one-on-one video sessions. We’ll welcome you into our community and give you 24/7 access to personalized tools to manage your OCD symptoms—all built by people who have been through OCD themselves and have recovered—as well as themed support groups, direct therapist messaging, and much more. 

Schedule a phone call with a member of the NOCD Care team to learn more about how a licensed OCD therapist can help you get better. This consultation is free and doesn’t take very long—and it could be one of the most important calls you ever make.