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Treatment for obsessive-compulsive disorder.

Two effective forms of treatment for obsessive-compulsive disorder have evolved during the past two decades. Behavior therapy, often called behavior psychotherapy, and drug treatment, using medications that have specific effects on serotonin neurotransmission, have produced encouraging results.

Although the combination of behavior and drug therapies is most effective, some patients have experienced relief through one or the other.

Behavior therapy has helped patients learn how to diminish anxiety arising from obsessional thoughts and reduce or eliminate compulsive rituals. It is a set of techniques the patient learns to employ whenever beset by a thought known to trigger anxiety and lead to rituals.

In effect, patients resolve to face the things they fear and resist carrying out compulsive rituals. These exposure and response-prevention therapies can be performed gradually or rapidly (like climbing to a feared height or entering the ocean from shallow water).

Many patients are pleasantly surprised to discover that with very little discomfort they can deal with longtime obsessions and compulsions by persevering in behavior therapy. Obsessions begin to fade, and the urge to perform rituals diminishes. The process is neither quick nor simple, but can be effective for many if followed methodically and persistently. When a planned program is pursued, taking on only a few obstacles at a time, moderate success can be expected.

Occasionally, patients become more anxious than usual when beginning behavior therapy. They may encounter moderate success, then suffer a setback. This, say the experts, is the moment when the objective should be pursued even more fervently.

Finding a well-trained and experienced behavior therapist requires diligent searching. The probabilities of falling into the hands of an incompetent or uninformed practitioner are likely. Guidance can be obtained by contacting the Obsessive Compulsive Foundation. The address and telephone number are listed on page 4.

Drug therapy should be administered by a competent psychiatrist whose experience with OCD patients is up to date. Only two medications that enhance serotonin transmission in the limbic system of the brain have been shown to reduce obsessive-compulsive symptoms.

These medications are reported to be effective antidepressants also.

Clomipramine (Anafranil) and fluvoxamine (Faverin) have been studied for more than 20 years in clinics around the world and are reputed to be safe and effective when administered and monitored carefully. Some patients have reported such side-effects as dry mouth, rapid resting heart rate and constipation. Other possible side-effects include sedation, increased sweating, difficulty in urinating, weight gain, blurred vision and temporary lowering of blood pressure.

Experts say common side-effects usually decrease as patients grow accustomed to the medication. The makers of clomipramine report that most patients experience little difficulty with the drug.

A third drug that shows some promise is flyoxetine (Prozac), another serotonin agent. It has suffered some negative publicity but numbers several esteemed professionals among its defenders (see Dr. David Comings' article on the subject).

The length of therapy varies among individuals. While some patients benefit from long-term drug therapy, it is unnecessary for others. The course of treatment should be developed individually by the physician.

Anti-obsessive-compulsive drugs are metabolized by the liver after passing through the bloodstream into the brain and body tissues. From the liver, the drug is excreted into the bile and eventually passes through the intestinal tract. Individuals with liver problems should inform their doctor of their condition because liver disease, in some cases, can affect metabolic pathways.
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Title Annotation:includes list of common obsessions and compulsions
Publication:Nutrition Health Review
Date:Jan 1, 1991
Words:560
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