Reader’s Question

I am a 19-year-old male and I have been diagnosed with OCD and Major Depression. I’m not that convinced that medications (SSRIs, etc.) are the real answer because they probably don’t treat the “roots” of my problems. In a way, it seems like lying to myself to just take a pill to alleviate my symptoms. Should I should seek Psychotherapy (CBT, etc.) as an alternative? What are your thoughts?

Our Clinical Psychologist’s Reply

Most treatment providers recognize the benefits of a multi-faceted approach to treating both Obsessive-Compulsive Disorder (OCD) and Depression.

Behavioral Treatments for OCD have a well-established track record of effectiveness. Typically, the treatments combine “exposure” techniques with “response prevention” exercises. Over time, a person learns to tolerate formerly anxiety-evoking situations and resist the urge to engage in troubling rituals. Studies have even shown that the same biochemical changes that occur in the brain as the result of treatment with medication occur with successful behavior therapy. Adding the “cognitive” component to the behavior therapy (as in CBT) appears to enhance the process in many cases. The value of traditional psychotherapy is somewhat more uncertain, although in some cases there can be some underlying “dynamics” fueling the symptom picture.

Cognitive and Cognitive-Behavioral treatment for Depression is also well-established and effective. A number of studies attest to the increased effectiveness of combining medical and cognitive treatments for depression. Cognitive therapy involves primarily challenging and changing cognitions that often accompany depressive episodes.

There are some individuals who appear able to overcome their difficulties with OCD and Depression through Behavioral, Cognitive, or Cognitive-Behavioral treatments alone. The potential added benefit of this appears to be an increased sense of personal efficacy. However, most individuals appear to benefit from a combination of medicine and other therapies. Sometimes, medication is needed early on in treatment to reduce high levels of anxiety and depression sufficiently for the patient to stick with and more fully profit from the other therapies.

It’s always a good idea to explore your treatment options. There are many professionals who specialize in the treatment of the disorders you describe and who stay abreast of all the available research and subscribe to a more comprehensive orientation with respect to patient care.