Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Can OCD be treated without medication? Experts weigh in

Mar 27, 202410 minute read

Being diagnosed with OCD can bring a wide range of emotions. On the one hand, you’re face-to-face with the fact that you have a serious, chronic mental health condition—but on the other hand, your struggle has a name, and your condition is highly treatable. Finally, you’ve figured out what you’re going through, and you can get better! Millions of people worldwide have freed themselves from the clutches of OCD, and you can do the same. 

Your diagnosis is an important answer, but many questions still remain. What’s the best way to get better? And does it have to include prescription medication?

As it turns out, most cases of OCD can be successfully treated with exposure and response prevention therapy (ERP)—no medication required, explains my colleague April Kilduff, LMHC, LCPC, LPCC, a therapist who specializes in treating OCD. So if you’re asking yourself whether OCDS can be treated without medication, the simple answer is a resounding “Yes!” 

That said, prescription medications can be a lifeline for many people with OCD, so it is a discussion you’ll need to have with an OCD specialist who understands the ins and outs of your unique situation. In the meantime, let’s explore the role and limitations of OCD medication, and how OCD can usually be treated without it.

How can OCD be treated?

Treatment for OCD typically involves a specialized form of therapy called exposure and response prevention (ERP), which helps you get comfortable facing your fears without doing compulsions—which only make your fears worse over time. 

“Often we will just try the ERP first without meds and see if it gives you the progress you need—and for a lot of people, it’s all they need to be in recovery,” says Kilduff. There are other therapies that can aid ERP without the use of medication, as we will explore later. Lifestyle changes can be helpful, as well.

Medication can help people with more severe cases of OCD participate in ERP so they can regain control of their lives. So, while OCD can usually be treated without medication, your specific treatment plan may be different depending on your symptoms.

However, no drug addresses the root cause of OCD, so whether you take medication or not, you often need therapy to enjoy lasting results. Let’s see why.

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Why OCD can be treated without medication

Before we dive into how OCD is treated, we need an understanding of how OCD works. People with OCD have obsessions and compulsions that interfere with their relationships, school, or work, and overall prevent them from living life to the fullest.

For many people, OCD is a vicious cycle that starts with an intrusive thought. While nearly everyone experiences intrusive thoughts, people with OCD tend to 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.

You put a lot of stock into these obsessions, and may feel the need to do compulsions to try to feel better or prevent something bad from happening. These compulsions may include reassurance-seeking, avoiding situations that trigger you, and doing mental behaviors (like excessive praying) or physical behaviors (like excessive handwashing in the case of contamination OCD). 

Doing compulsions may make you feel better in the short-term, but this only serves to reinforce the cycle, teaching your brain that your obsessions hold weight and you really do need to do compulsions to stay safe. The key to treating OCD is breaking this cycle. To do this, you should seek the help of a therapist who specializes in OCD. Some treatments that work for other mental disorders can actually backfire for OCD, so you need a therapist that recognizes the unique needs of OCD patients.

A skilled, licensed therapist will likely help you break the OCD cycle with ERP. 

The most proven therapy for OCD treatment—ERP 

Exposure and Response Prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD) and has proven to be highly effective in teaching people to manage OCD symptoms long-term and break the OCD cycle. This is true for children, adolescents, and adults struggling with any theme or subtype of OCD.

“Research generally shows ERP to be as effective, at the very least, as first-line medication therapies for OCD,” says Paul Greene, PhD, licensed clinical psychologist and director of Manhattan Center for Cognitive-Behavioral Therapy

In ERP, you desensitize yourself to your triggers by facing your fears in a safe environment. Here’s how it works: You work with a trained therapist who specializes in OCD to rank your fears from least to most stressful. To start, your therapist will generally encourage you to face a less stressful trigger. Let’s say, for example, you avoid knives because you have intrusive thoughts of stabbing people. You may start ERP by simply looking at a picture of a knife. The discomfort will likely come up, but you learn to tolerate it instead of fighting it. When nothing bad happens, or you realize you handle the discomfort better than you expected, you start to become more comfortable, and then you progress to more challenging triggers.

The more you face your fears, the more your brain starts to realize it had nothing to fear in the first place and that compulsions were never necessary to keep you safe. You’ll eventually reach a point where you can be in a room with knives, or perhaps even use knives to make dinner, without being riddled with fear that you’ll lash out and hurt someone.  

As the Chief Clinical Officer of NOCD, I’ve seen the benefits of ERP in my personal practice. One patient was preoccupied with the possibility he had health issues. He went to doctors for years and wanted every test in the world. When each came back negative, he was down about the fact everyone was missing that something was wrong with him. A doctor gave him an antidepressant, which did nothing to help. He continued to do more and more research and tried to find more and more doctors. He saw a therapist who taught him to try to ​​relax using deep breathing, muscle relaxation, and meditation—but these turned into compulsions for him.

By the time he came to NOCD, this man’s compulsions became so time-consuming that he had trouble functioning. His relationship was suffering and he missed work to the point he lost his job. His ERP involved gradually cutting back on the research he was doing and the number of doctors he was visiting. As he did fewer compulsions, he had more time to be with his wife and work on their relationship. Eventually, he got to the point where he had a job back. He still has intrusive thoughts about his health, but they no longer interfere with his life. He’s able to accept them and move on.

It’s important to note that ERP can be challenging, and requires intention and commitment. Sometimes, ERP will need to be supplemented with other treatments. These may include medication, but not always. Other therapies can also boost the effectiveness of ERP.

Other helpful tools for OCD 

Though the first-line treatment options for OCD—ERP therapy and certain medications—are usually needed to conquer the condition, there adjunctive strategies that many people use to boost their progress and maintain management of their symptoms over time. To help you out, your therapist may recommend strategies such as the following:

  • Acceptance and commitment therapy (ACT): ACT encourages you to accept your thoughts, emotions, and urges as neutral, rather than as good or bad. Learning to do this might help you do ERP more easily.
  • Healthy lifestyle practices: A 2023 study found that OCD patients who exercised more often had better improvement in OCD symptoms during therapy. 
  • Family or community support: A 2014 study found that family involvement had a large impact on OCD symptoms and overall functioning. “Getting family involved can be helpful, since you’ll have other people help hold you accountable,” explains Dr. McGrath.
  • Support groups: Having OCD can be lonely if you feel you’re the only one having these thoughts and doing these compulsions. It’s comforting to spend time with people who understand and support you, and it can motivate you to stay on top of ERP. “That’s why we have so many support groups at NOCD,” says Kilduff. “Those can be great touch points in between therapy sessions.”

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

A few different medications can help treat OCD. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most popular. They work by increasing the levels of serotonin, a neurotransmitter that regulates mood, in the brain. 

Tricyclic Antidepressants (TCAs) are another type of medication that may be used to treat OCD. They work by affecting both serotonin and norepinephrine, a neurotransmitter that plays a role in your “fight-or-flight” response.

Atypical antipsychotics are sometimes used with SSRIs or TCAs for people with severe OCD symptoms. They work by affecting dopamine, which plays a role in mental health conditions such as OCD. 

Medications can help some people with OCD tackle the challenges of ERP therapy in several ways:

  • Lower anxiety: Many people with OCD have a lot of anxiety, which makes it hard to do ERP therapy. Medications can help take the edge off anxiety and make it easier to tolerate exposure to feared situations or objects, which is a vital component of ERP therapy.
  • Better ability to resist compulsions: One of the goals of ERP therapy is to help people learn to resist their compulsions or rituals. Medications can help you experience fewer—and less intense—obsessions and compulsions.
  • Better ability to adapt your thinking: People with OCD often have rigid thinking patterns and may struggle to think flexibly or adapt to changing situations. Some medications improve cognitive flexibility, making it easier for people to learn and apply new coping strategies during ERP therapy.
  • Improved mood: OCD can be highly distressing and debilitating, and people with OCD may struggle with depression or other mood disorders, which can affect motivation. Medications can help improve mood and reduce the overall burden of symptoms, making it easier for people to do ERP.

Any decision to use medication for OCD treatment should be made in consultation with a qualified healthcare professional who has specialized training and experience in OCD treatment—they can help assess your needs and determine the most appropriate treatment plan.

Even if you decide to take medication for OCD, that doesn’t mean you have to take it forever. “Medication makes some patients more able and willing to step in to do some of the scary tasks that we ask people to do in ERP,” says Kilduff. Once patients get the hang of ERP and are in recovery, many patients can work with their doctors to taper off the medication.

“We see whether the successes and gains they got in ERP are maintained or if they kind of start to dwindle as the med goes down?” explains Kilduff. While some people may need medication long-term, many people “realize they can get off the med and use what they learned with ERP to stay in recovery and to handle lapses when they come up.”

Limitations of medication for OCD

While medications can help you manage OCD symptoms, they have several limitations when used alone.

Firstly, medication only targets the symptoms of OCD and does not address the underlying psychological factors that contribute to the disorder. Therefore, medication alone might not provide long-term relief from OCD symptoms. Medications are not a substitute for therapy and they’re typically best used in combination with ERP. If you’re not in therapy, your symptoms may return when you stop taking the drug.

Secondly, medication can have side effects, which some people may not be able to tolerate. For example, SSRIs can cause nausea, insomnia, and sexual dysfunction, among other side effects. Some people also experience withdrawal symptoms when discontinuing the medications.

Thirdly, medication may not work well 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. 

“I’ve worked with people who a lot of people will start with medication because it requires the least effort,” says Kilduff. “People want that magic pill, so they start with meds and they might have a little bit of relief, but not the complete recovery they hoped for, and so, at that point, your only option is to reach out and do therapy.

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