Medication
In this section I will share my understanding of medication for OCD
However, before I start, I wish to put the disclaimer that I am not a medical professional. If you have any questions regarding medication, including whether you should take it or not, please see your doctor
The most common form of medication for OCD are Selective serotonin reuptake inhibitors (SSRIs). They were originally created for depression, hence why they are also called anti-depressants, but it was discovered that they could also benefit anxious patients
The general understanding is that anxious patients have a chemical imbalance, in particular, they don’t have enough serotonin
Let me explain this chemical imbalance theory and how medication is meant to help
Serotonin is one of the happy chemicals
For a person to be happy (and therefore not anxious), serotonin has to be spread to enough nerve cells in the brain.
The spreading of serotonin is meant to work like this. All nerve cells in the brain have a small gap between them. Certain nerve cells produce serotonin and want to pass it onto the nerve cells that need it. Those nerve cells that produce serotonin cannot directly give it to the other nerve cells.
Instead, they deposit the serotonin into the small gap between the nerve cells, and hope the nerve cells that need the serotonin just take it from this small gap. If the serotonin is not taken from that small gap, then the nerve cells that created it just take it back. So, the serotonin is not spread to the nerve cells that need it.
What SSRIs are meant to do is stop the nerve cells (that produce the serotonin) from taking it back. So, the serotonin sits in the small gap until the nerve cells that need it are ready to take it
This is the most common explanation for how SSRIs work. It dates back to the 1960s. However, when you dig deeper, you can find many flaws with this chemical imbalance theory. These include:
1) When the medication is taken, the serotonin levels increase almost immediately, but the reduction in symptoms (anxiety, depression etc) can take up to two months to come through
2) Many drugs that increase serotonin are wholly ineffective in treating anxiety and depression
The below articles in the 'Guardian' and ‘Psychology Today’ talk about this in more detail. Admittedly they concentrate more on depression than anxiety, but according to popular theory, both conditions stem from chemical imbalances, so what applies to depression can also apply to anxiety
https://www.psychologytoday.com/gb/blog/insight-therapy/202006/is-psychology-broken
If anxiety (and depression) isn’t a chemical imbalance, what is it?
Modern thinking suggests that anxiety (and depression) is a problem of circuitry, not chemistry. In this view, symptoms of anxiety (and depression) result from failure of synapse formation and changes in the activity level of various emotional signalling centres, set in motion by overactivity of the stress response system, often in response to early adverse experience
What the above means in simple terms, is that it is stress that causes mental illness. This is different to the chemical imbalance theory, which says that is missing chemicals that cause mental illness
If it is stress that causes mental illness, then it is further evidence that psychoanalysis has the best understanding of psychology. This is based on the part of the above modern thinking paragraph that states ‘overactivity of the stress response system, often in response to early adverse experience’. This fits in perfectly with psychoanalysis i.e. negative childhood experiences can cause mental health issues
Despite the above, for some people, SSRIs do help. So, if your anxiety is severe enough, you should seriously consider taking it. When they work, they can reduce the anxiety significantly
SSRIs do have drawbacks, in the form of side-effects. When you first start taking them, it is common to get things like diarrhoea, headaches, and feeling disorientated. But they tend to go by around two weeks
However, for some people, there is one side effect that lasts as long as you are taking the medication. This is the feeling of numbness. You can become so numb for example, that your ability to taste food is reduced. Basically, your ability to feel all emotions (positive or negative) can be massively reduced
If you need to take SSRIs for many years, then this numbness could be a problem. However, if you do therapy (such as CBT), then within a year your OCD anxiety could reduce significantly, so you could reduce the dose of the medication, thus reducing the numbness. Or, if you are lucky, you could stop taking the medication completely, and manage the remaining anxiety symptoms using the tools that therapy teaches you
Not all people get this high-numbness side effect. So its down to luck
If you are not prepared to take SSRIs due to their side-effects, there are two more medications that you can try
These are Pregabalin and Propranolol. They both have less side-effects compared to SSRIs, but the reduction in anxiety is also a lot less. I took Propranolol first, and the reduction in anxiety was around 2%. I stopped taking that and then tried Pregabalin , and the anxiety was reduced by around 3% to 4%. These medications did not help me significantly enough when I was taking them, so I ended up taking SSRIs. But it could be different for you
To be clear, medication, of whichever type, do not stop OCD thoughts. They reduce the amount of anxiety the brain produces to those OCD thoughts.
The next section is on food - please click the button below