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Obsessions and Compulsions People sometimes over think somethings, sometimes. However some people really really really over think a lot of things a lot of the time. If it is disabling, it is part of obsessive compulsive disorder, O.C.D. The other part of OCD is compulsions. Compulsions are an intense need to perform some type of ritual or custom as part of routine activities of daily living. Like having to tap a tube of toothpaste three times before putting it away. Or having to recheck the stove to be sure it is off over and over again. If these rituals are not typical for that persons culture and they interfere with your life significantly, then that is a compulsion. Excessive washing ones hands, and germ phobias are another example. Counting mundane objects is another example of a compulsion. Some people with OCD have obsessions, some have compulsions. Some have both. OCD is highly neurophysiologic. OCD has been shown to occur from irritation of specific points of the subcortical brain structures such as the caudate nucleus. The subcortical part of the brain is the "primitive" non thinking part of your brain deep in the center. OCD is highly genetic. This means it runs in families. It is often genetically paired with anxiety, tourette's (muscle twitches), and ADHD. How does talk therapy work? OCD patients need talk therapy in order to change their thought patterns and OCD spirals. Think of your brain like a muscle. The more you give in to the OCD urges, the more you are training your brain to think and behave OCD- ish. The therapists is like a trainer in a gym. The therapist guides you to think differently. This trains your brain to relax. The neurophysiology of OCD is strong. Exercising your brain with talk therapy is usually not enough for moderate to severe symptoms. The longer a person has OCD, the harder it is to break it. OCD gets more permanent the longer you have it. So, you should use all your weapons to defeat it. Medications are a powerful weapon in your arsenal. It should not be ignored. The medications for OCD are the following groups. 1. SSRIS (selective serotonin reuptake inhibitors) 2. Tricyclic antidepresants 3. Antipsychotic/mood stabilizers 1. SSRIS include Prozac, Zoloft, Paxil, Lexapro, Luvox, Celexa, lexapro. These meds including their side effects are covered in more detail under my description of "Depesion medications" page. Basically, the idea is that working through the serotonin system, these meds decrease the OCD symptoms. SSRIS are first line treatment because they work well with light side effects. The ones that are most irritating that occur more than once in a blue moon are tiredness, 5 lb weight gain, sexual side effects. These side effects are usually mild and well tolerated especially when compared to the benefits. Scarier but very very rare side effects are bone loss and gastric bleeding, All medications are serious, all meds have a risk of death, although extremely unlikely. Look at tylenol's side effect profile someday for comparison. 2. The tricyclic antidepressant medications described in more detail under "antidepressant medications" page are stronger than the SSRIS but also have more risks of side effects, some serious like a heart attack others uncomfortable like sedation and blurry vision. This is usually a second line medication for OCD. But don't let its second line status fool you. It works really well and is usually tolerated just fine. It is a nice add on med to an SSRI. 3. Antipsychotics are a third line option. These meds are now often called mood stabilizers because they are also used to treat bipolar disorder, Tourettes, depression, anxiety, eating disorders. They have the most serious side effects discussed under the pages of "bipolar disorder treatment". In conclusion, OCD is a treatable condition. It is something that for most people, professional help is needed. One should get treatment as early as possible and not let the disease fester. Like most medical conditions, the longer it persists, the worse it gets, and the harder it is to fix it, sometimes it can become so entrenched, treatment can become only partly effective. However, the good news is early treatment seems to be very successful. And, treatment no matter how late seems to be able to reduce symptoms significantly. Mitchell L. Glaser, MD. Chicago IL |
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