A significant number of people who suffer from Obsessive Compulsive Disorder (OCD) also suffer from depression. While the exact mechanics are not fully understood, It is believed that OCD often increases depressive symptoms, sometimes leading to major depression, although OCD can exist in non-depressed individuals as well. Similarly, depression can involve OCD components, as well as lead to their manifestation over time. When OCD and depression occur together, it can be more challenging to decide how to best treat the patient. Seratonin-Reuptake Inhibitors (SRI´s) may or may not be totally effective at controlling both the OCD and the depression at a given dose, and, at the same time, it is often desirable to make the medication regimen as simple as possible. The effects of some medications, when taken simultaneously, counteract or exacerbate the effects of another leading to undesired effects, and sometimes a single medication would be effective for both OCD and depression, but at different doses. This presents a complex situation for assessing which treatment of combination of treatments will work best in a given patient´s situation.
However, promising new research indicates that exposure and response prevention (EX/RP) therapy for OCD may be effective at reducing depressive symptoms in OCD sufferers, making it a promising treatment for OCD sufferers who also experience depression . In a recent study¹, depressive symptoms decreased over a 32-week follow-up time period during which participants suffering from both OCD and depression received SRI treatment plus EX/RP. The authors of the study concluded that the results suggested that EX/RP brings about decreases in depressive symptoms for co-OCD sufferers largely by decreasing OCD symptoms, among people who are already taking SRIs. This has important implications for people grappling with OCD and depression as well as those treating them.
EX/RP is one of the most commonly used methods falling within the Cognitive Behavioral Therapy (CBT) spectrum of treatments for OCD. EX/RP works upon the principle of habituation. In EX/RP, the individual is exposed to the focal points of her or his OCD cycling, be they thoughts, images, experiences, or objects, beginning with small amounts. With OCD, these items typically trigger the acting out of compulsions. With EX/RP, the individual is taught to resist engaging in the compulsive response to the anxiety trigger, which, over time, retrains the brain to view these triggers as less threatening, bringing about a drop in anxiety when exposed to these triggers. This allows the person to slowly loosen the ropes that bind them to the anxiety and the related compulsive behavior.
When depression stems from OCD, it is often caused by the disruption to the normal life functioning the individual experiences due to the obsessions and compulsions that take over the “alarm system” in the brain, causing them to respond to the triggers as if they are in danger. All of this is extremely taxing and disruptive to the person´s life as well as to the delicately balanced feedback systems in the brain and body, and can lead to a physiological cycle of depression. It is thought that, by releasing the sufferer from some of the anxiety and compulsions tied to the OCD triggers, the individual experiences a reduction in depressive symptoms as their life and physiological systems are able to return to their more balanced feedback loops.
For more information, see http://www.researchgate.net/profile/Yinyin_Zang/publication/273834585_Change_in_Obsessive_Compulsive_Symptoms_Mediates_Subsequent_Change_in_Depressive_Symptoms_during_Exposure_and_Response_Prevention/links/551991cb0cf26cbb81a2acd9.pdf
¹Torp, Nor Christian, Kitty Dahl, Gudmundur Skarphedinsson, Per Hove Thomsen, Robert Valderhaug, Bernhard Weidle, Karin Holmgren Melin et al. “Effectiveness of cognitive behavior treatment for pediatric Obsessive-Compulsive Disorder: Acute outcomes from the Nordic long-term OCD treatment study (NordLOTS).” Behaviour research and therapy 64 (2015): 15-23.