Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder in which people suffer from repeated, unwanted thoughts or ideas (obsessions); engage in irrational repetitive behaviors or mental acts (compulsions); or both. Carrying out the compulsive behaviors tends to ease feelings of anxiety, while repressing compulsive behavior causes stress.
Several integrative interventions, such as N-acetylcysteine, glycine, and inositol have been shown to reduce OCD symptoms in clinical trials.
Signs and Symptoms
- Mental obsessions and behavioral compulsions, with four subtypes:
- Symmetry or order, things need to be “just so”
- Forbidden thoughts or images: an affected person will seek reassurance that they are a good person, ask forgiveness and pray
- Cleaning and fear of contamination
- Hoarding (listed as a separate mental illness in the latest Diagnostic and Statistical Manual of Mental Disorders [DSM-5])
- Tics (sudden, brief movements or sounds) or evidence of excessive handwashing may be signs in some cases
Causes and Risk Factors
The causes of OCD are not yet fully understood, but several factors seem to be involved:
- There may be abnormal structure and activity of certain parts of the brain and of the neurotransmitters serotonin and dopamine in patients with OCD
- Lower estrogen levels in both men and women are associated with OCD symptoms
- Life events such as stress or trauma can modify the gene expression of serotonin and dopamine, which may lead to OCD
Conventional and Emerging Therapies
Conventional treatment for OCD includes both pharmacological and non-pharmacological therapy:
- Cognitive-behavioral therapy, which seems to be more effective than selective serotonin reuptake inhibitors (SSRIs) in patients with OCD
- SSRIs and the tricyclic antidepressant clomipramine (Anafranil) (a non-selective serotonin reuptake inhibitor, or SRI) are both considered first-line pharmacotherapy for OCD.
- Deep-brain stimulation involves the surgical implantation of electrodes and is FDA approved to treat chronic and severe cases of OCD.
- Amisulpride, a second-generation antipsychotic drug that is widely available outside the United States, modulates the action of dopamine in the brain.
- Repetitive transcranial magnetic stimulation (rTMS) is being investigated for OCD; it involves stimulating specific brain regions through the use of magnetic current.
Dietary and Lifestyle Changes
- Exercise may reduce anxiety and depression, symptoms that often accompany OCD, and may increase the ability to tolerate normal stress.
- Stress reduction, as stress may exacerbate OCD because it can reinforce compulsive behavior.
- Inositol: In a double-blind controlled trial of patients with OCD, oral inositol resulted in a significant reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score, while placebo treatment resulted in average Y-BOCS score reductions of less than one point.
- N-Acetyl L-Cysteine (NAC): In a randomized controlled trial, 48 patients with OCD who had not responded to a 12-week course of high-dose SRI medication received either additive NAC or placebo for an additional 12 weeks. In the NAC group, almost 53% had a full clinical response (defined as a decrease in Y-BOCS score of more than 35%), while only 15% in the placebo group achieved a full clinical response.
- Glycine: In a randomized controlled trial in OCD patients, very high-dose glycine or placebo was added to ongoing pharmaceutical or behavioral therapy. Patients in the glycine group experienced a mean decrease of over six points in Y-BOCS score compared with a mean one point decrease for those receiving placebo.
- Milk thistle: A double-blind randomized trial in participants with OCD compared milk thistle extract to fluoxetine (Prozac). Judged on the basis of change in Y-BOCS scores, milk thistle extract and fluoxetine were similarly effective.
- Valerian: In a placebo-controlled trial of valerian root extract in patients with OCD, those taking valerian showed statistically significant reductions in Y-BOCS scores at four, six, and eight weeks compared with those taking placebo.