How Depression Makes OCD Recovery Harder (and what to do about it)

ByOctober 31, 2018Uncategorized

Comorbid OCD & Depression

Approximately 1 in 40 people deal with OCD worldwide, and more than half will also experience at least one major depressive episode during their lifetime. 

Most people with OCD and depression experience depressive symptoms as a response to the distress caused by OCD. Fewer become depressed first, or develop both depression and OCD simultaneously. Those with upsetting or taboo intrusive thoughts might feel particularly confused and distressed by their symptoms, making them even more prone to clinical depression.

Imagine you’re a fifth grade teacher with OCD dealing with intrusive thoughts and violent mental images about hurting people you care about. Every time you see a potentially dangerous everyday object like a stapler or a pair of scissors in your classroom,  you think about using the object to hurt one of your students. You’d never act on these thoughts – that’s what makes them so upsetting. But they’re becoming so frequent that you start to worry the thoughts hold meaning. Are you a violent person? Do you actually want these scenarios to come true?

Of course, this teacher isn’t a threat to children at all – she just has OCD. But without treatment, her thoughts will continue to spiral, making her feel even more anxious and upset. They may cause her to question her morality, withdraw from her students, or even quit her job, leading to more severe and more frequent obsessions, depression, or both.

Why ERP Might Not Work for People who are Depressed

Perhaps because OCD is typically the primary diagnosis in comorbid cases, people suffering from both disorders often don’t receive appropriate treatment for depression, even when they do receive treatment for OCD.

Typically, people with OCD achieve at least partial relief from exposure response prevention (ERP), a derivative of cognitive behavioral therapy (CBT) considered the gold standard treatment for OCD. But researchers at the University of North Carolina, Chapel Hill found that ERP is virtually ineffective for patients with comorbid depression who aren’t treated specifically for depression first. The team, led by OCD specialist Jonathan Abramowitz, PhD, treated half a cohort of people diagnosed with comorbid depression and OCD with cognitive behavioral therapy for depression followed by ERP for OCD, and the other half with ERP alone. The group that received treatment for depression was more motivated and better able to stick with ERP through challenges, more willing to engage in regular daily activities they enjoyed, and more confident and better prepared to address their OCD in therapy compared to the second half of the group. Two-thirds of the patient treated for depression experienced a reduction in OCD symptoms by 50% or more. Patients who practiced the same amount of ERP but received no treatment for depression did not experience a significant decrease in symptoms for either disorder.

One reason ERP is often ineffective for people struggling with depression is because the lethargy, lack of motivation, and feelings of helplessness symptomatic of clinical depression make starting and sticking with ERP particularly challenging. People who are depressed also tend to have extremely negative beliefs about themselves and the world, and might feel hopeless and unmotivated towards recovery, or undeserving of treatment in the first place.

Treatment Options for Depression

In Dr. Abramowitz’s research, cognitive behavioral therapy for depression helped patients reframe thoughts. CBT for depression teaches us to reframe a pessimistic thought like “I’ll never get better so I shouldn’t even try” to be more reflective of reality, for example: “I’m suffering right now, and I am worried I won’t recover. I know I won’t feel better all at once, but with hard work and dedication I can work on feeling a little better every day.” Dr. Abramowitz explains that spending the first few sessions helping patients develop new strategies for thinking and behaving helps them overcome some of their depressed feelings, and “increases their motivation to engage successfully in exposure and response prevention for OCD.”

Other treatments for depression include medications like SSRIs, which are often prescribed by psychiatrists for OCD and for depression. Some people who don’t experience a decrease in depressive symptoms from first-line treatments like CBT and SSRIs, might consider a treatment like ketamine therapy: a fast-acting solution for treatment-resistant major depression, which works by promoting materials necessary to make repairs to communication systems between areas of the brain responsible for depression, anxiety, and other forms of stress damage.

Because depression is such a prohibitive factor to treatment for OCD, NOCD is working to make innovative treatments like ketamine more readily available to people in our community who have both OCD and depression. That’s why we’ve partnered with Actify Neurotherapies, a leading provider of ketamine therapy with treatment centers in Maryland, Florida, New York, North Carolina, and Pennsylvania.

About Actify Neurotherapies

Dr. Steve Levine, a board-certified psychiatrist and the founder of Actify, used to prescribe typical first-line antidepressants to patients in his private practice. SSRIs usually take weeks to months before people notice a difference; some people wait weeks just to find that the medicine didn’t work for them. Some of Dr. Levine’s patients were frustrated with common side effects from first-line medications for depression like weight gain, sexual dysfunction, gastrointestinal disturbances, sleep disturbance, fatigue, and emotional blunting. Others tried multiple medications, but didn’t experience a decrease in symptoms with any of them.

That’s when he founded Actify, to offer ketamine infusions to people like his patients. Ketamine has a 70% response rate and sets in immediately, so people experience quick results. The 30% of people who don’t respond to ketamine will know almost immediately, helping them to avoid wasting time and money in the long term. Side effects are limited to the second half of the forty minute treatment, and typically include blurry vision or double vision, a feeling of intoxication or some physical numbness, euphoria, talkativeness, or a feeling of being disconnected. Some people experience a few minutes of headache, nausea, or sweating, but patients don’t experience side effects after the infusion is complete. Dr. Levine knew ketamine was a great option for people dealing with inefficacy or side effects from other treatments – and his patients over the past few years agree!

If you’re dealing with comorbid OCD and depression, you might find OCD treatment particularly difficult, and that’s why we’re working to make more resources for depression available to the NOCD community. To sign up for Actify’s ketamine treatments for depression, fill out this form!

If you have questions or comments about Actify, depression, or OCD, please reach out to, or give us as shout out on Facebook, Instagram, or Twitter @treatmyocd.

Phoebe Kranefuss

Author Phoebe Kranefuss

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