Depression and obsessive compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is a specific anxiety condition that involves both unwanted thoughts, urges and fears (obsessions) that are connected to repeated behaviors and/or rituals (compulsions) that are used to try to relieve the stress of these feelings. There is often a large delay (over 10 years in some studies) between experiencing symptoms of OCD and getting treatment*. Up to 75% of people with OCD have major depression*1. Because OCD was described in detail by some of the people we interviewed, this part of the website focuses on OCD, its relationship to depression, and potential treatments. (For more information on anxiety, see ‘Depression and anxiety‘.)

Noticing obsessive tendencies early in life prior to depression.

Several of our participants noticed that they were particularly concerned with ‘perfectionism’ early in life. Maya said, ‘I was off I think part of it was that I’m unusually fixated. I think I was just, you know, more intense as a kid.’ Colin also says he had perfectionistic tendencies as a child, but they didn’t ‘get out of hand’ until he reached college.

OCD behaviors and their impact on everyday life

People we interviewed talked mainly about compulsions, rather than obsessions. Obsessions can be highly distressing, and often include unwanted thoughts about aggression, harms to self and others, sex, contamination, or order and symmetry. People we talked to described several different behaviors that they associated with their OCD. These included checking things multiple times (such as doors, lights, or ovens), repetitive handwashing, or counting. Leanna says, ‘I would pick things up and this was part of the OCD too. I would pick things up, put a different thing down. I would constantly, I still check things, check doors multiple times and lights and especially ovens. I’m terrified of things burning this house down’.

Colin thought his obsessive tendencies and depression are related, describing his issues with OCD as the ‘driving force of my depression’. Nadina felt these obsessive tendencies were a way to cope with her feelings of not being good enough.

Nadina describes how handwashing gives her a sense of control.

Age at interview 23

Gender Female

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I check things multiple times a night, I repeat things over and over [laughs] if I don’t think I did it right, just that, in that particular way. Handwashing a whole bunch. Making sure pretty much [laughs] every inch of my body is clean. It’s kind of a living hell sometimes and, but I feel like it’s me coping with not feeling good enough and like so, you know, if I’m not feeling good enough that particular, particular day, oh maybe if I arrange my, [laughs] my credenza you know all the stuff differently maybe I’ll feel a little better, you know. Or maybe if I wash my hands 20 times you know I’ll feel like maybe I won’t get sick in the next week or something like that you know, so it’s almost like tying these loose ends of things that I think are in disarray and since I feel a lack of control in my life and like what’s happened to me when I feel in control of certain little things that gives me some type of, I don’t know, completion, or something like that.

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These symptoms progressed, for Colin, to something he would do when he heard others talking. ‘I would take the words they were saying,’ said Colin, ‘and I would do the same thing with the syllables. And I would be sitting in lectures the first semester of college, university and just wouldn’t have any idea of what I was listening to. It would just be processing it as numbers and repeating those strings in my head’. His difficulties finishing assignments and exams led him to take a semester off and seek psychiatric help.

Colin discusses the increasing severity of his OCD symptoms.

Age at interview 20

Gender Male

Age at diagnosis 18

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After my senior year of high school during which it was still bad, but I got through it, it was a lot better than my junior year. I went to college at a university and my OCD and depression just came together to create this perfect storm and just, I was not a functional human being. I wasn’t going to class, I couldn’t get out of bed, I wasn’t completing any of my assignments. One of my biggest issues with OCD was I take an incredibly long time to finish assessments and things for various reasons. And I just wasn’t finishing any of my tests, I would get them about half done. I was just going throughout the day with these terrible thoughts, I felt so worthless. I, I with, the only thing I had ever been good at my whole life was academics, I got straight A’s in high school and all of a sudden that was all falling apart and I had nothing that I was really, to define myself by besides depression and compulsions and obsessions and that was pretty much my entire life. And I would just these thoughts all day, that weren’t mine [laughter].

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Treatment for OCD

Medications and specific kinds of cognitive behavioral therapy are frequently used to treat OCD, often in combination with each other. Colin went to an intensive outpatient program specifically for OCD treatment. As part of the program, he logged the number of times he experienced symptoms and learned strategies to combat his anxiousness, such as breathing techniques.

Colin describes his experience in an intensive outpatient program.

Age at interview 20

Gender Male

Age at diagnosis 18

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I was logging these numbers, and at first when I came in, I felt so broken because one, I was in a terrible mood at this point. I was going through a depressed episode right at the start of the session of the program. And I was in there with, they made it a community thing.

Where you would start off every day, I would go in there every day of the week for maybe five hours. And they started off each one with people saying out loud how many tallies they had for each thing. And I was the youngest person in there by far. I was still 18 at this point. Everybody else in there was in their late 20’s, early 30’s, some people in their 40’s and I was maybe one of 10 people in that room. And I just, it made me feel worse hearing all of these tallies because everybody was like, Oh ten for this, ten for that. I tried not to listen to what their specific things were.

But maybe 20, maybe 30, but every time that I would repeat mine, especially for the numbers and counting section I’d come in and have to say like, 310. Or 350. And then it would start going down as the program went on, maybe like 290, 280. I was still so much higher than everybody else and I felt so hopeless. And I would go into this program every day and then after we finished that report with our statistics, I would be given these. I had this binder of exercises to work on. I don’t remember what they called them, but you would rate your level of anxiety that it gave you to think about a certain scenario.

Such as, and I still do, but I used to have a really bad issues with having to do everything in 3’s. And it would be, you would start with the things that were the easiest.

And get those out of the way to get a momentum, things that gave you the least amount of anxiety. And so I might start like, Oh think about only tapping the wall twice. Or something.

And then it would say, maybe I would rank that as a five out of ten. And then you would start timing how much time passed until you finally gave in.

And at first even little things like this were so hard, I would give in about after maybe 30 seconds or 40 seconds and I would have to like tap the wall three times, just because I thought I was going to go crazy. But then after you start doing that and really just, I did these breathing exercises and you would just focus and concentrate and try to lower your anxiety, they taught us techniques for that.

Did that help?

Yeah, it did. Definitely.

Is it something you can still tap into? Is that a tool you have now?

Yeah, because I still go therapy every week. And we do a lot of the same thing.
But yeah, I still do that. Maybe I’ve neglected it a bit, but I still keep my binders and my exercises and stuff to go back to. And so yeah, I just keep working my way up and then after you can say, Oh, I went X amount of time and I actually got my anxiety down to a 0 for this scenario. And move on to the next one and it took a while but you were there for about five hours a day, so you have a lot of time by yourself to do these things.

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Colin also discusses the medication he was prescribed to help with his obsessive tendencies and how it gave him the control he needed to work past them, but did not help his depression symptoms.

Colin talks about how medication helped his OCD, but not his depression.

Age at interview 20

Gender Male

Age at diagnosis 18

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And she prescribed me like [unknown medication name], Lexapro, instead of fluoxetine and I started off about with low to average dose and I don’t think it helped much. It definitely didn’t help OCD at all, it might have helped my mood a bit, but when I went into the program one of the psychiatrists there said, especially for obsessive compulsive disorder, they usually have you on a much larger dose. So I doubled my dose when I was there and the medication regimen combined with the program was actually very helpful together. It, the medication kind of gave me enough control in order to work on these issues.

So the medication was, was handling your mood?

The medication actually handled, once I was on the higher dose, handled obsessions and compulsions better than my mood.

Ok.

I wasn’t very happy like with what it was doing with my mood.

That was one thing that didn’t change substantially during that time, but I stopped getting a lot of obsessive thoughts on the medication just, even without trying, like I was trying really hard, but even some things that I hadn’t worked on started dissipating.

And I thought that was magical [laughter] at the time.

And then after this program I continued that medication regimen, kept doing the exercises they taught me back while being enrolled in university after having left the program. And I got through my first semester of school and it was so hard, but I worked as hard as I could and I did very well. I fell back to where I had been in high school, like all A’s. All I did, I got a 4.0 my first semester. I was taking fairly hard classes. I, it was, took a lot of effort but I made it back [laughter] to where I was. And then I thought I was in such a good place that, with my obsessive compulsive issues, that I stopped the medication because I didn’t want to be on it any longer and that was a bad idea [laughter]. Because I don’t think I realized how much it had helped my mood. Like I did, I thought it was, like I was really disappointed with, because I still felt, I still had suicidal ideations, and I still had no desire to wake up in morning, I mean.

While you were on the medication or after you started?

No, while I was still on it.

Ok.

But my OCD symptoms were so much better.

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References
* Glazier, Kimberly, et al. “High rates of OCD symptom misidentification by mental health professionals.” Ann Clin Psychiatry 25.3 (2013): 201-209. *1 Quarantini, Lucas C., et al. “Comorbid major depression in obsessive-compulsive disorder patients.” Comprehensive psychiatry 52.4 (2011): 386-393.
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