Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Do I have to take medication to get treatment for OCD?

By Patrick McGrath, PhD

Jun 09, 20224 minute read

Reviewed byDr. Jamie Feusner, MD

I often get asked by new members, “Will I have to go on medication?” My answer is always the same: “That will be a choice that you will ultimately make for yourself, just like you will ultimately choose to do therapy or not do therapy.” 

I mean that with all seriousness: I will not force therapy on someone, and I will not make anyone who is in therapy with me take medication. I might make a recommendation that a person get an evaluation for the possibility of taking medication, but, just like I cannot make a person attend a teletherapy session, I also cannot make someone take medication either. 

So, why is this an important question to ask? Simple—there are numerous people who call us at NOCD and ask us in their initial call if we will make them take medications. I want to assure you that we will not be making anyone take medication while they are in treatment with us here at NOCD. Again, we may recommend receiving an evaluation for them, but we will not make you take one. That decision will be one that you make in conjunction with your therapist, your treatment team, your general practitioner, a psychiatrist, and/or even your family and friends. 

Currently, the American Psychiatric Association’s practice guidelines say that there are two recommended first-line treatments for OCD: ERP or medications. Many who do not respond well enough to either alone will do best with ERP plus medications. I am comfortable providing treatment to people who are and who are not on medications. And, for the most part, medications do not interfere with the therapy that I am providing—unless the medications are benzodiazepines (more on that in an article to come). 

Your personal health decisions are always your choice

No one has to do therapy. Think about that for a minute: If you reach out to us here at NOCD, we are not going to force you to do treatment—simple as that. It will be up to you to decide to do OCD treatment. Now, there may be many motivators that your friends or family try to use to get you to do therapy: Your family may end all accommodations for your OCD, such as no longer buying you 7 bars of soap for each day of the week, or they may decide that if they want to put their feet up on the coffee table, they are just going to do that. 

You may accept this or rally against it, but you will still have the choice to do therapy or not do therapy. Granted, I believe that your life would be much easier if you chose to do therapy, but I would not force therapy on anyone, while at the same time I could encourage others to stop accommodations for OCD. 

In a similar vein, taking medications as a part of treatment for OCD is also a very personal decision. If I am working with someone and they tell me that they do not want to be on medications, I let them know that we will start to do therapy without medications, though I do reserve the right to recommend them if I feel they will assist in the therapeutic experience. 

Even then, it will ultimately be the choice of the person doing the therapy to take medications or not. They may still oppose medications, and I might even say that I will no longer do treatment with them unless they decide to take them. This is only if, in my clinical judgment, taking them would be in their best interest—this is my ethical duty and, more importantly, this is because I care about them getting better—but I cannot force them to do so. 

All that being said, many people that I have treated have not been on medications. Additionally, not all medications are the same: I have much more difficulty working with people who are taking anti-anxiety medications, such as benzodiazepines, because they can actually interfere with therapy. In fact, one way is that it can create state-dependent learning, where people learn that the only way to deal with anxiety is to take a benzodiazepine. 

Don’t let a fear of medication stop you from getting treatment

So rest assured that you will not have to go on medication in order to get treated for OCD. Could medications be a helpful adjunct to therapy if you choose to try them? They may very well be, but that decision will be up to you in conjunction with the people that you choose to include in your treatment decisions. 

I hope that this will help to allay any fears that you may have about starting therapy. Do not let a fear of medication be an impediment to doing OCD treatment. And, do not let OCD tell you that they will make you take medications because that is just a lie. 

If you have other questions or would like to learn more about getting treatment at NOCD, please don’t hesitate to schedule a free 15-minute call with our care team.

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