The OCD would be due to a lack of serotonin in the brain. The drugs mainly used increase the amount of serotonin in the synapses (junction between two neurons) by preventing the reuptake of the latter. These drugs are called serotonin reuptake inhibitors. They facilitate the passage of the nervous message.

The main selective serotonin reuptake inhibitor (SSRI) antidepressants prescribed are:

• Fluvoxamine (Floxyfral® / Luvox®)
• Fluoxetine (Prozac®)
• Sertraline (Zoloft ®)
• Paroxetine (Deroxat® / Paxil®)
• Escitalopram (Seroplex® / Lexapro®)
• Citalopram (Seropram® / Celexa®)

They are effective on OCD after several weeks of treatment. Treatment usually lasts several years. In case of reappearance of the disorders, the dosage can be increased or a new molecule tried. More than half of the patients would see their condition improve thanks to an adapted drug treatment.

Clomipramine (Anafranil®), which belongs to another class of antidepressants, the tricyclic antidepressants, and which was first shown to be effective in OCD, may also be prescribed.¹⁶. It is usually used as a second line, if the first drugs have not been shown to be effective, since its side effects can be significant.

The doses prescribed for OCD are usually higher than for the treatment of depression. If the treatment proves ineffective, a psychiatrist should be consulted because other molecules such as lithium or buspirone (Buspar®) can be tried.

Anxiolytics belonging to the benzodiazepine class may be prescribed to reduce anxiety. For example, clonazepam (Rivotril®) has shown some efficacy in the treatment of OCD. However, risks of mood swings, irritability and suicidal ideation have been reported.¹⁷.

Electrical stimulation, used in Parkinson’s disease, has had some results in severe or treatment-resistant OCD¹⁸. Deep brain stimulation (DBS) involves implanting electrodes in the brain and connecting them to a stimulator that delivers an electric current. This invasive technique is still experimental¹⁹. Less invasive, transcranial magnetic stimulation (sending a painless magnetic pulse through a coil) can be offered.

The disorders associated with OCD also need to be managed.

Treatment for obsessive-compulsive disorder most often involves behavioral and cognitive therapy. This therapy aims to decrease the anxieties related to obsessions and to reduce the compulsions caused by these obsessions. The sessions can consist of practical exercises, the person finding himself confronted with situations that he fears, relaxation or role plays.

Drugs and psychotherapies can be combined and have been shown to be effective. In fact, two thirds of the patients treated would see their disorders decrease. The combination of the two is generally offered directly in the event of severe disorders or after failure of a single drug.

Sometimes the disease is resistant to treatment. This usually applies to people with severe disorders who also suffer from bipolar disorder and eating disorders. Hospitalization may then be necessary.